Experiences and learning points from starting FY1 on night shifts

Graduating from medical school, I felt an immense sense of achievement- after the years of hard work, I was finally going to be a doctor! It was so exciting, but as that first wednesday of August loomed, I became gradually more and more nervous. I was starting in general medicine, with my first ever shifts as a doctor being night shifts, meaning I was also due to miss the departmental induction. On the advice from my medical school friends, I was able to arrange three hours of shadowing out of hours for the week before I was due to start, and a departmental induction for myself and a colleague who would also be missing out otherwise. These proved to be incredibly valuable as they allowed me to familiarise myself with the hospital, the bleep, and the various other systems I would need to be working in, before being thrown in the deep end. Whilst I would encourage anyone to make the most of shadowing opportunities, if you find yourself to be the unlucky doctor starting your first shift on call, I would highly recommend asking your trust about the opportunity to shadow an on call FY1, so that you know what to expect from your shifts, and know when and where to attend handover. 

As the evening of that first Wednesday arrived, I packed my (multitude of) snacks, my water bottle, my coffee, my stethoscope and my new (doctor!!) name badge. I was welcomed by kind colleagues at handover, who knew it was my first day. Handover finished, and suddenly I was sent forth into the hospital with a bleep, a jobs list, and the contact numbers of my on-call colleagues. It was not long before I was bleeped, being addressed as “doctor” and asked to review patients. In that moment it suddenly all felt very real, and despite my years of training at medical school, I suddenly felt paralysed by the responsibility of it. What if the paracetamol I had prescribed at what I knew to be the appropriate dose was somehow dramatically wrong? What if my A-E assessment had overlooked something key and I’d completely misunderstood what was happening to the patient in front of me? My on-call team was fantastically patient and happy to answer my many questions. Especially for the first on calls you do, it can be helpful to clarify with your seniors how they prefer to be contacted- usually via either bleep or phone call. Making a whatsapp group chat can be helpful, allowing you to ask non-urgent questions or get a second opinion on a tricky ECG- just make sure there is no patient identifiable information in the chat. 

When you first start work, it can feel incredibly overwhelming when the jobs list feels impossibly long, and it feels as though you are expected to know everything. In these situations, it is best to keep things simple: do the most urgent jobs first, if you don’t know where to start an A-E assessment will rarely fail you, then come up with a plan and escalate to your seniors early if you are concerned about a patient. In my first months of work, I received feedback from colleagues that despite my lack of confidence, my decision making was good. A basic, sensible plan is better than no plan, and the biggest increase in my confidence has come from ensuring that I have formed a plan prior to discussing with my colleagues. As the FY1, you are not required to know everything, and so forming a simple initial plan until a senior can finetune things is all you need to do. To aid this, I can highly recommend bookmarking your most used trust guidelines (antibiotic policy, electrolyte abnormalities, management of diabetes, chest pain) on your computer login as it will save you large amounts of time. 

It takes time to adjust to your new role as a doctor, and I’m only starting to feel now, six 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, 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, and you too will have become a colleague with valuable experience to share.

Dr Nomi Fischer

F1, North West of England Foundation School

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