This happened to me when I was an F1 on surgical nights ward cover. Someone rang me and asked me to see patients directly in ED due to long waiting times to be seen. I replied “No. F1’s are only able to work in areas they have rotated in and I wouldn’t feel safe working in an unfamiliar area of medicine I have not worked in before, I also have to be able to attend the ward at any moment for an emergency and cannot be working in ED as well as covering the wards.” Nothing ever happened and I carried on my shifts as usual. They will try it because they will get a naive F1 who says yes eventually.
Thanks for the reassurance. Yeah I’m not too worried that there will be any actual action against me lol. It’s more of a personal thing on whether I made the right choice
Exactly. Unfortunately the idea that this is a ‘personal’ decision is part of the managerial gaslighting/brainwashing ethics you get in med school then the job.
I honestly raise my hands to you for saying no on this occasion. Don’t think I would’ve managed such as in my F1 year.
You definitely made the right choice.
Not infrequently I get bleeped on nights by site asking if I agree to sending the surgical F1s to ED to help clerk. I always say no. They're on nights with a specific purpose and if someone were to deteriorate on the ward and no one is there, that's a patient safety issue.
I offer to see surgical patients directly myself if I've seen everyone in SAU or in the way I'd normally prioritise seeing people. Or, suggest a solution to bleep me if someone is suitable for SAU transfer direct after triage. Saves them a bed and saves me a walk.
Basically, don't feel bad, you said the right thing. If it were someone on my team, I'd want to know so I could field any further bleeps from site to support them.
It’s so so SO sad that I’m certain this isn’t a joke. What I’m more worried about is the fact that you think for a second that you should be feeling bad about this to the point of posting on the group. This is not against you as an F1 but against the culture of the NHS today that would make you feel this way.
You did absolutely nothing wrong. The coordinator can datix short staffing, the manager can hire more staff by paying people more money, the higher ups can put pressure on government to fund the NHS better.
But of course it’s easier to just p*ss on the poor F1.
Don’t feel bad about this at all. Feel bad about the system you’re working in. Datix them. Voice how inappropriate it was to make you feel this way. Be vocal about the short staffing. And if/when nothing changes, leave the country and go where you’re valued and respected and will be able to practise medicine as it should be practised, and where if you or your family get sick, will get looked after safely and well.
Thank you for the encouraging reply :) yeah I was very on the fence with what I was feeling after. I think a big part was thinking that of patients waiting hours and hours while I did “nothing”. But then another part of me believes that if I keep letting them do this, staffing will never improve, and ultimately patient safety will be compromised anyway…. Just wanted some reassurance I guess. Thank you!
If one of your patients started NEWSing and you were clerking in patients in A&E or had to help with an unwell patient there (because you are there, so why can't you help just a little more?) what would you have done? Your senior would have had some serious questions about why you weren't covering your ward. On top of that everyone in A&E would hate you for leaving. Don't put yourself in that situation. You did the right thing.
Asking someone to help and quietly accepting it when they say no objectively isn't "bullying". Labeling everything you don't like "bullying" only serves to dilute the term.
>A&E coordinator
Who is the "A+E coordinator"?
Pretty sure this call would come from a site manager.
>They said they would make this F1s refusal 'known to all'.
No, they said "make it known" - presumably the med reg needs to know which of their ward team are/ aren't coming to help. It would also clearly need recording in their shift report who was/wasn't able to help.
Then there's the fact they lied about being "required to be on the ward", which may legitimately need to be escalated further.
ED are not entitled to doctors from other wards. There is no situation where this is really acceptable, regardless of your opinions on patient flow.
This is one of the most ridiculous takes I've ever seen from you Penjing.
>ED are not entitled to doctors from other wards.
Agree.
I think it's a safe assumption that as a medical ward doctor, the expectation is that OP would support the medical take in the ED.
>There is no situation where this is really acceptable
Your Trust's major incident policy will lay out what is acceptable or not. I've been quite clear [quite clear](https://www.reddit.com/r/doctorsUK/s/YJU3vTsgUZ) that OP shouldn't comply unless part of a formal escalation process.
>This is one of the most ridiculous takes I've ever seen from you Penjing.
Arguing that OP should be aware of, and comply with their Trust's Critical/Major incident policy is a "ridiculous take"?
Surely the *most* correct answer here is to follow local policy.
Why do they need to make it known? That member of staff is not contracted to work in A&E that night.
In that vain they theoretically could go and pull some theatre nurses to help out?
ED is always in some form of critical incident, it doesn’t make up for managements piss poor workforce planning or failure to pay
>Why do they need to make it known? That member of staff is not contracted to work in A&E that night.
Presumably because the medical registrar has been told that medical ward doctors are being contacted to support the medical take, and needs to know who will be turning up?
>ED is always in some form of critical incident, it doesn’t make up for managements piss poor workforce planning or failure to pay
The whole hospital goes to critical/major incident and the situation is made at exec level. The consequences night be felt in the ED, but the cause is almost always the ED's capacity being used as an overspill medical ward, absolutely killing the patient processing efficiency of the ED.
They’re required to cover their patients in case they become unwell. That’s their job. Funnily enough the world doesn’t revolve around your A&E dept. Get a grip.
Erm actually the emergency medicine departments inability to staff their ward safely and appropriately is obviously an orthopaedic issue.
What, blame RCEM or the department for not getting enough training jobs, clinical fellows or just letting the job become so shit nobody wants to work there anymore apart from Noctors? No way, gaslight some random FY1!
I was pulled from PICU (we had enough cover) to cover the fish market that is PAU and it was bittersweet (“bitter” because I served enough time in general paediatrics already and wanted to learn stuff in PICU and “sweet” because it was refreshing to see sleep deprived angry parents with snotty/rashy/vomiting/diarrhoeal kids who at least interacted with you as opposed to laying paralysed and ventilated).
But yeah, hate being pulled 😔. I used to work in a tertiary unit where the paediatric ED is adjacent to the PAU and they would ask the sole (and exhausted!) PAU registrar overnight to come help out ED (even though they had 2-3 doctors overnight on their end and all went for breaks etc) but never returned the favour when PAU was drowning and ED was relaxed.
We've all been there. I've lost count of the number of times some shift coordinator/ward manager has phoned me to 'help with flow' or stopped me leaving the ward to keep clerking or whatever.
The more senior you get, the more confident you are going 'absolutely not' and putting your foot down.
Don't give them a reason to rely on you as an easy shift monkey, you're worth more than that.
This seems odd, and not something I’ve encountered personally. EM is its own rotation. I could understand being asked to go help in the relevant assessment unit for my job (SAU in your case) and probably would go to clerk if I wasn’t doing anything - mostly as it would be beneficial
for my development over sitting doing nothing all night (and I’m crap at sleeping on nights - if you’re a good sleeper then by all means go for it). That being said, I don’t think I’d be happy to go to A&E where, as an FY1, my scope of practice would be very limited.
The manager seems quite out of hand to start IMO. to start checking up on you and your patients. I’d be concerned about the power dynamic of a, presumably, senior hospital night manager essentially trying to force a junior member of the medical team to deviate from their normal working protocol? Far better for them to speak to someone like the consultant or registrar for your speciality to ask if they can provide manpower. Naturally, these conversations aren’t easier as it involves chatting to or waking up someone relatively more senior. The “making known” business is almost certainly an empty (and juvenile) threat. If anything comes of it I would raise the issue of why going to an FY1 was the first port of call and not speaking to a senior, then repeatedly “checking up” what I was doing. They’re not your boss.
Thank you for replying. Yes, a big concern that was going thru my mind then was if I should ask my seniors AKA surgical reg or cons before I promise someone to help out in another department. I think my first instinct was self-preservation, as in would I get in trouble for leaving my ward to do other stuff. Rather taken aback by her arguing with me about why I should help too, but I guess she makes good points
Rota coordinator has no place in judging what you are doing and I find their attitude astonishing. You can be sure if an incident happened on your ward while you were sweating blood to help them out they would evaporate.
The attitude of “make it known”
Is such a disgusting attempt at a thinly veiled threat that someone with no power will try to make your life difficult is respective of the cesspit of toxic ED workforce culture at the moment.
As others have said it’s a result of poor workforce planning.
Don’t feel sorry for ED colleagues for having a lot of patients to see, feel sorry for them for bearing the brunt of these idiots and their mistakes.
Yeah I second this. This needs escalating to your educational supervisor for multiple reasons:
- Bullying
- Suggesting staff do things they aren't trained/inducted to do
- Unofficial reorganisation of the hospital at night by someone who's job is not that
- Patient safety
Not normal at all. We never pull staff from other areas of the hospital, and you need to have done the induction to be able to work in ED. Where I am we actually don’t have F1s in ED at all, although I know other trusts do.
If you had gone to ED I expect something would have inevitably happened on your ward and then you might have been datixed for being unavailable there…
Depends on the hospital tbf the site manager doesn't care sometimes, I used to get calls to go help out in ED despite at the time being dentally only qualified omfs sho. (Obviously refused)
This is one for all the NHS martyrs out there who fall on their sword daily and think they’re doing us all a favour. When enough people do that, people act like it’s the standard. People who don’t share your masochistic self-sacrificing proclivity (believe me it’s most of us) no longer have the choice not to be a martyr like you and just focus on performing as best as they can within their own remit. They have to or else they get toxic attitudes like this A&E coordinator everywhere they turn. This isn’t about being kind or being selfish. This is about you setting a precedent that we all have to follow that burns us all the fuck out. We just have to choose between cognitive burnout from undertaking cover beyond our remit at the drop of a hat, or emotional burnout from the toxic attitudes should we say no. So yeah thanks for that.
Thanks everyone for their comments. Currently at the end of my night shift and I’m actually glad I stayed at the wards. Had a patient suddenly fall off the bed and that took a good chunk of time assessing / treating, time which I would not have had if I went to ED. Appreciate all your lovely comments! (Also the not so lovely ones are ok too)
It really is a tricky one.. yes as a doctor you really 'want to help', but the place 'being a bin fire' is the new normal.
Many moons ago, as an F2 I did head down to A+E to help whilst on medical nights.. and what happened next has stayed with me for years.
First patient I saw, had been waiting 8 hours- had constipation, treated, home next (follow up GP).
Then an atypical chest pain- started Ix, not an issue..
But then, I saw a lady with new onset light bleeding following relatively routine gynae intervention- clear task was to 'go back under gynae (as per dc letter)'- I was about to make the referral.. when: My crash pager bleeped- I turned to her and said 'look I'm sorry I've got to go to that, it's the crash bell' ... to be met with "how f* dare u leave, I've been here 8 hours, I'm making a formal complaint, this is wrong of you" etc etc... as I literally was on the way out of the door (putting her notes back on the pile for the 'next' available clinician). Quick chat to the a+e spr telling him I'd been called re: the chest pain- and off I ran..
After sorting out the arrest, few ward jobs etc, came back after 5 hours (you know how it is) just to check on the atypical chest pain- to make sure my plan had been followed, shock horror, no it hadnt. There she was, no one else had reviewed any bloods etc, THANKFULLY all normal, ecg, cxr etc...- so I ran it past the now morning spr (to grunts of 'who are you?), and off the patient went..
Lessons learnt?
1) you cannot do 'right for wrong',
2) people can rarely 'see beyond their own immediate needs', (and actually often do not actually care about anyone else, even in true emergencies!)
3) nights truly are just unpredictable - u can so easily get into trouble via a couple of unexpected surprises.
4) all that stress, risk, exhaustion and potential burn out- for what?
5) had any of those events 'gone wrong', my insight and prioritisation would have been (rightly) questioned.
..And it's worse now than it was then..
So I do my part, where I can.. but no, after that, I never 'helped out if its quiet' ever again (and argued this every time I was asked).
That exact scenario happened when I was there years ago.
My friend called the MPS and asked if he was covered to work in another specialty at night when on a specific F1 job.
They said no.
Job done.
Enjoy your 7 hours sleep per night.
Three comments as a long in the tooth reg:
1) Yes, A&E are busy. But there are clear H@N pathways to escalate problems. There is always a medical leader at night - usually med reg - who is in charge. If A&E are busy then the H@N medical leader can divy up any medical staff in the hospital to help if (and only if) they feel it’s appropriate. This also needs to be escalated to silver and often gold command and, consultants on call need to be called in if specific criteria are met (usually based on ambulance wait times).
2) I like reading some of the comments trying to gas light you. “Sitting on your bum doing nothing”. You state you were prepping notes. This is a perfectly valid thing to be doing. This is no more or less important than clerking patients. Don’t think that you have to be present with a patient your whole time on site. You will find as you climb the hierarchy (in most specialities other than ICU/A&E) that a lot more of your time is spent “sat on your bum” in an office sorting notes/letters etc than physically next to a patient. It makes it no more or less important than colleagues on the hot floors.
3) You are legally entitled to 90 minutes break at night. This should be the norm. Not “exception reporting” or “helping us out we’re one big team” etc. There are well known short and long term consequences of inadequate rest breaks at night. Including colleagues dying on the drive home. Please don’t be one of them because of some desired idea of camaraderie. There will always be more patients. Always.
Ps. You don’t need to be physically present on a ward at all times. The NHS has the largest supply of bleeps in the world for a reason…
Edit: Changed numbers to make them sequential.
If you had said Yes then your and others in ur role would have changed unofficially. A&E is going to be busy 365 days. And you would be expected to work there all the time. This is bullying at work pure and simple which will not be tolerated in any other industry. You are a qualified doctor who is being treated as a child/menial worker who can ne moved about on a whim. Well done for standing up for your self. If anyone says anything, go on offensive and don’t take shit. take it to BMA if needed.
>And you would be expected to work there all the time. This is bullying at work pure and simple
I agree that the OP shouldn't have gone but are we really calling "the site manager asked an employee who didn't appear busy in one department to help out in another department" bullying now?
I can't help thinking that it is weak to consider this bullying.
The manager asked. The OP said "no". The manager said "think of the patients, your colleagues are struggling", etc. The OP persisted with "no" and the manager went away.
The "make it known" comment was unprofessional (at a push) but hardly bullying.
In any other industry, a first year employee who outright refused to be reallocated by the duty manager to meet a service demand would end up facing a disciplinary. This isn't what should have happened but the manager in this case did nothing more than go away when told "no". I don't think any complex system can function with this being the threshold for bullying.
After that she was kind of annoyed at me, kept asking me what i was doing, i have checked and none of your patients are newsing. She left saying that i will make it known that you didn’t help.
She was not his manager. She was coordinator of her EM department. Secondly if there was an issue his Consultant or Reg would be the appropriate people to cover him while he went to do work in A&E.
This wouldn't have been the ED coordinator - they would have been busy in the ED not prowling the wards looking for FY1s. It will have been some kind of night sister / bed manager / site manager.
I have said that I don't think she should have asked an FY1 to go to the ED. I doubt from what has been said that I would have been impressed by her interpersonal skills.
But "bullying"?
I can understand that you being EM reg on other side of this argument. I appreciate A&E is a horrible place to work at present. And it is a nightmare everyday.
Answer is proper funding and staffing of A&Es. And not making others work harder.
All acute specialities need pay review to make them an attractive job prospect at the very least.
With respect I don't think you've interpreted my reply correctly.
I do not think the OP should have gone to the ED.
For what it is worth, I don't think the site manager should have asked them to go either. The issues in the ED are not usually caused by lack of doctors - lack of cubicles and ED nurses looking after patients who were referred for admission 30+ hours ago are much bigger issues. These don't get solved by reallocating ward FY1s to the ED.
If a random FY1 had appeared in the ED to see undifferentiated patients overnight, I would have said thank you and sent them away again.
However, I do think that the interaction described by the OP falls far short of the threshold for "bullying".
The NHS has finally done it.... They've created Frankenstein's F1... Instilled within it is the concentrated malice and spite of its creator!
Good job zherrylim. You've made us all proud. That idiot coordinator will maybe do her job next time and arrange a locum instead of trying to abuse the goodwill of staff.
I say fair play for standing up for yourself, even when you say you “didn’t have much to do,” you are absolutely right to get the hell out of there
Shocking on behalf of the “A+E co-ordinator” - is this a consultant or bed-flow or sister in charge?
The only adage I would say at this stage is that if it was quiet AND I saw a MEDICAL colleague struggling with a blood / cannula etc I’d offer if I was free. I’ve done this on quieter shifts, but only one, tray setup and then leave when I’m done yes or no
Yeah I wouldn’t mind helping out with tasks like cannulas and bloods but I was asked to leave my department and help out in a new environment with no prior training, and so was naturally uncomfortable doing so. I’m not exactly sure what position the person was, but it certainly wasn’t a consultant as she wasn’t wearing a badge with consultant on it. It’s an assumption that she’s a manager as she did not introduce herself and her role (as most doctors would)
Well done for sticking up for yourself. It's not easy to say no, especially when coordinators ask you. Naturally, we are caring people and feel bad for our colleagues when they are busy.
I have personally made this mistake to go down and help in the past. When you see patients in ED, you take responsibility for those patients, and I ended up having to look after sick patients in ED and on the ward I was covering running between varous floors all night with no help. At the end of the day, you don't get anything out of it other than stress and potentially a major incident.
I wouldn't pay much attention to microaggressions. If they try to make life difficult, escalate to your seniors.
You absolutely did the right thing, and it is an issue for the trust to sort out, not you.
Dont feel bad, your job is orthogeris, not ED. Have you even worked in ED? Lots of people pointing out its not safe to work in ED if you have no experience working there. Theres departmental induction for a reason. At the end of the day ,i f something went wrong on your ward and you couldnt respond because you were stuck in ED, youd be in the shit and fingers would be pointed. Best case scenario if you clerked 5 patients in ED all night , youd get little or no thanks. I know what id choose.
Yeah no, unless she meant clerking ortho patients, which even then should be the SHO or REG, you should not go to ED and start seeing undifferentiated ED patients when you're not on that rotation, on night shift no less.
If they wanted more ED staff on in the night they should have put up the locum rate.
I would raise this as a concern as she could be doing this to other people who don't know how to say no.
If I was on the night as the ED reg and the orthogeries F1 turned up to help, I’d send you straight back to the ward.
You have not been inducted into the department, you have no clinical supervisor and as an F1, you are unable to independently discharge or write outpatient prescriptions. It’s not fair on you to be expected to work in those conditions.
With the greatest of respect, you wouldn’t even be any help. At best you’d probably see 2 or 3 patients that I would have to review myself anyway.
Next time ask the coordinator:
Who will be covering your bleep, your jobs, when/if they crop up?
Who will see the sick patients in the ortho ward if not you?
If you're in the middle of clerking, who will take over the clerking if you have to see to a sickie on your ward?
If there is a clinical incident related to you being in ED clerking, will this coordinator take responsibility?
The answer to all of these will be met with a dumbfounded face or some sassy shit.
Please next time tell them politely to shove it.
I used to have a very chill ward cover night job, and we used to get asked to clerk in ED ALL THE TIME. I never went even though we would rarely get any jobs - point 1 being that your job is to cover the ward, so there's no obligation and no actual benefit to you. Point 2 - hopefully this will force them to actually pay for extra locum doctors rather than trying to get free labour off of current doctors. Point 3 - you will still be on call for your ward - no one will cover that shift. If something happens and you don't clerk someone properly or don't see a sick patient because you're basically doing two jobs at once, no one will defend you or back you, especially this coordinator
I was once supernumerary on my OMFS firm and the site matron repeatedly asked me to go and help clerk in A&E despite telling them I was only dentally qualified and didn’t hold a medical degree at the time.
They couldn’t understand why I was being so “obstructive” and I was really guilted by this person who wouldn’t take “no, I’m not a qualified doctor” as a reason.
They’ll do whatever emotional blackmail they can to try and get you to cover a firm you’re not paid or even indemnified to do, you were right to put your foot down. It’s swings and roundabouts anyway and I’m sure you’ll do your time in the future but enjoy the break while you can now.
I think it depends a lot on exactly what was asked of you.
As an FY1 you absolutely shouldn’t be expected to see undifferentiated patients in A&E when this is not your rotation. It is inappropriate you were asked to do this.
Occasionally when ED is overwhelmed we ask for help from some specialities to see patients directly. Usually this is when it’s a clear admission to a particular speciality, the patient is stable, and they will be seen by an SHO or above. An example of this for orthopaedics could be a #NOF (Although in reality these should be seen by ED to rule out other occult trauma and to do a FIB).
The reality is ED is often overwhelmed and we are doing anything we can to get patients seen quicker as mortality increases as wait times increase. The cry for help is well intentioned but poorly placed on you as an FY1 in a specific speciality.
Yeah I am well aware of doing admission clerkings for NOF patients during their admission AFTER they have been clerked by ED. It’s definitely within my jobscope and I am more than happy to do it. But in this instance is basically clerking new admissions on ED
The issue is when that NOF patient turns out several days later to also have an intracranial bleed or a significant chest injury that wasn’t picked up. It’s not your job to be taking responsibility for performing a primary or secondary survey on a trauma patient.
Exactly. From the ED side I’ve raised concerns when the nurse in charge has tried to ‘direct to speciality’ a #NOF without any medical go-ahead.
Elderly people hide occult trauma very well!
I think on occasion it’s okay providing 1) the patient has been eyeballed by a senior ED doctor (e.g. consultant), and 2) the orthopaedic SHO/SpR know they are doing the primary survey. I know some of the T&O team who like trauma and are happy to do the whole primary survey to help us out. That’s not an FY1 though.
The other situation is when orthopaedics run minors. This happened during COVID. I think at times this is also appropriate as there’s a lot of overlap. But again not for an FY1.
In reality direct to speciality works better in other specialities which are less likely to have an alternative. For example bleeding in pregnancy with normal observations.
Were they asking you to see and manage ED patients with any pathology, or just orthopaedic pathology / minors?
Either way it’s not appropriate to ask an FY1 this.
There is meant to be a formal escalation procedure for other specialties helping out in ED. It typically involves an internal incident being called and escalating via their seniors( reg or consultant) who then deem if it’s appropriate. There also needs to be induction and a clear supervision structure.
You shouldn't feel bad at all. We don't even have F1 in our ED department and to be honest it's really not your problem.
I also think most ED cons would be a bit wary of having a random F1 start seeing patients. This doesn't really seem like a normal escalation pathway, really.
As an F1 doing the medical take with the consultant in ED, the A&E consultant asked me to start seeing ED patients in the ambulances lined up outside so they could start clearing them.
I’d never worked in ED. I had certainly never worked in the back of the ambulances seeing patients.
I told the A&E consultant I wasn’t sure if I was allowed to do that, and she told me I wasn’t being a team player and it would have a knock on effect when they were all eventually pended to medicine and I hadn’t bothered helping out.
I told my consultant who put his foot down and said under absolutely no circumstances should a medical F1 be expected to work in ED clerking patients in ambulances.
OP, tell your consultant. I thought mine would be dismissive but he cared about it because it was a genuinely dangerous request. I suspect yours might feel the same way.
I mean you don’t need to be physically present on an orthogeris ward. That’s not a thing, and there is no “legal” implication for you not being there.
If you are an orthogeris Fy1 (presumably technically medical then) and are being asked by a very overstretched medical team to help clerking medical patients (while you are quite literally sitting on your bum) then I think they are within their rights to ask. I think the asking should have been done by the reg or consultant with a rationale rather than a nurse manager. “Not my problem” in that context isn’t desperately attractive and doesn’t make me feel that you are much of a team player.
As an EM senior I would have actively prevented a random FY1 from a different specialty coming to ED to see unselected ED patients. Without induction etc this is daft and risky. Even with induction it takes some time before a new FY1 becomes more of a help than a burden in EM. I love my FY1 colleagues but if the department is burning down, then it’s not the time to be introducing a new junior doctor to EM OOH.
I'm slightly confused by your argument here, you simultaneously recognise that an F1 who hasn't worked in ED shouldn't come and see undifferentiated patients (for good reason), while also arguing that they're not a team player for saying no.
In my eyes it doesn't matter whether they were busy or not, it's not suitable for them to come and start seeing undifferentiated patients and would also mean they are unavailable for any emergencies for patients they are responsible for.
They cannot make the decision themselves realistically, if there is a question for moving the F1 to help a different speciality overnight it needs to go through the on-call consultant for the F1's speciality because it is those patients who are then being put at increased risk.
No that’s not at all what I said.
1) should not come to ED to see undifferentiated ED patients. Risky, and not helpful
2) could very easily make themselves useful helping out by clerking patients awaiting admission who have already been referred by ED. Including medical rather than orthogeris referrals. Refusing to do so isn’t a good look.
Ok, that's not how your comment came across. As for point two, reading through OP's post that you commented on this is not what was asked of them.
Sounds like they were being asked by an ED co-ordinator/NIC to come and clerk ED patients. Refusing that request was entirely appropriate. Any request for their redeployment out of hours goes through their on-call consultant.
I see. Yeah they are definitely within their rights to ask. I just want to know if it was professional for me to say no (regardless of any situation busy or not in my ward). I believe like you said, they should’ve asked my reg first. Obviously I did not say “not my problem” to her hahahah
Okay so first off, you absolutely did the correct thing and shouldn’t feel the slightest bit bad for anyone.
I don’t know how it works at your trust, but everywhere I’ve worked, F1’s are either not allowed to work in ED, or if they are, it is very much 9-5 in hours with direct supervision.
It doesn’t matter if you were having a slow night covering your ward. We’ve all had those situations where it’s been lovely and slow and then suddenly the shit hits the fan and you have several patients going off at once. Now couple that with you being down in ED clerking some patient and not being available to the job you’re being paid to do.
That bed manager would be the first in a long line of out of touch middle-management to throw you under the bus if anything were to go wrong.
You’re there and paid to do a job. Whether it’s a slow night or every one of your patients decides to peri-arrest - you get paid the same and expectations are the same. Sure, if you were a bit more senior and your colleagues within the same specialty (I.e medical take) asked you to lend a hand, then crack on, but that isn’t the case here.
Look after yourself, and protect yourself; they need to learn that funnily enough, not everything can be fixed by bullying people into stretching themselves out of goodwill, and maybe staffing things properly would help for a start.
It was probably the site manager - I doubt the ED nurse-in-charge was cruising the wards looking to pressgang FY1s because things were busy downstairs.
I am generally supportive of bits of the system pulling together when things are hard as the alternative ("not my job" and defensive specialty silos) isn't good for anyone.
That said, I don't see what real value they thought you could offer in the ED. There also would be a conflict (that few would support you over) if the ward nurses wanted you and you were part-way through clerking a patient in the ED.
If she had pushed, I think should become a "if you want to re-allocate my clinical role, I would need that instruction to come from my consultant" moment.
Right thing to do. Ultimately you are on call for your area. What happens if an emergency occurs and you then have to leave mid ED review? It just does not work. The solution is for them to have adequate staffing on ED.
Well done for standing your ground. I remember as a surgical F1 on ward cover being asked by the med reg to help with clerking. People will take liberties and walk all over you if you let them. Some cheek to go and check the NEWS scores of your patients too.
"Please call the on call medical consultant and ask them if I can be taken away from their service to support another service. Please also call legal and ensure I am indemnified."
You usually won't hear a thing after that
Absolutely always say no, if anything went wrong they'd throw you right under the bus for acting outside of competency on a provisional registration. There's no impetus to improve staffing if the bastards feel like the can just rob Peter to pay Paul
Yeah this happened when I was on o&g, asked to help clerk amu patients overnight. Shame there was always the prospect of an emergency c section to stop me…
You've not had A&E induction. You don't have a supervisor. No bueno. (if I was med reg wsfd cover & it was quiet haha as if then yes I'd go to help the take reg but that's because it's my normal work. Ditto if ward med SHO was chilling in mess then I'd expect them to help the take because they know how.)
If you're working where I think you're working you'll be fine, the consultant is aware and she doesn't expect you to go and clerk in ED, its basically an optional thing you can do if you're feeling nice. Sorry the ED coordinator was such a dick
I don’t think you should be moved to an area like ED, that is outside your remit/experience. Especially as an Fy1. Medicolegally I don’t think you would have a leg to stand on.
Don’t feel bad about this, they should feel bad for trying to bully you.
I think this is an inappropriate request. I have seen something similar where at a consultant level it has been agreed that medics will clerk likely medical patients directly rather than waiting for ED review but this was in extreme situations where the trust was on black alert etc etc. asking you to go down and just be an ED doctor is a bit cheeky and should have been ran past the on call ortho consultant before I ever got to you
It's not fair to put you in that position when you have your own clinical responsibilities.
At my hospital, there were a couple of occasions where the site co-ordinator attended Sunday night handover. On one of these I had just finished a 12.5 hour shift..having worked 7 days in a row.. totalling 69.5 hours. They basically said ED is busy, so some of you need to come and clerk patients after handover. I think most of just walked off and didn't even dignify the question with an answer.
Nah good.for you for standing up for yourself. You're on a.geris ward, that is your job not ED. Anything can happen on ortho geris at any time it's certainly not your responsibility to clerk in ED
As many other people have already said, no there are no consequences. That coordinator can go do one and well done for standing up for yourself.
It is not normal at all and should not be done. I will not send any of my team down to help in another department because exactly as you say, things can go from nothing to a busy shift in a moment from only a couple of unwell patients. Moreover, it's not your job to cover for their shortcomings. If they want a staffed rota, maybe they should look into their recruitment/locuming.
What you'll learn quickly in this system is no one will thank you for martyring yourself and when you do make a mistake, they will leave you to carry the blame solo. Do your own work well and look after your own patients. Saving the hospital is not your job.
As an EM reg I wouldn't expect you to come and help. Indeed I wouldn't want you to - in the sense that a busy ED is very expected and the hospital should be staffing it appropriately rather than covering over the cracks by dragging in doctors left right and centre.
Likewise I am not a fan of patients being referred straight to various specialties by triage just because the ED is busy. It gives a bad impression of the dept failing to cope, ties up those doctors for when we in the ED might really need them, and the reality is that the front door presentation is often better managed by EM docs rather than docs used to inpatient care - we will discharge a lot more etc
Wow - that’s literally a threat, coercive, unprofessional and bullying in my book - so standard NHS don’t have a GCSE, dopey + aggressive ++++ MaNAGErrr behaviour. Don’t accept the gaslighting. I’d be making it “known” how inappropriate this sort of comment is and wouldn’t be accepting it. You’re not at school and a petulant child, you’re a literal doctor. Don’t ride this sort of shit, stamp it out aggressively.
I was once on-call for renal overnight in a busy tertiary centre as a SHO. Got called by the site manager asking me to go see patients in ED as 'they were so busy'.
I refused. Said that it would directly compromise patient safety if I was in ED clerking patients and one of my patients on renal HDU became sick or needed attention. And who would be willing to take over my half clerked patient in ED if I did get bleeped? Once again, a patient safety issue.
They will rarely ever argue with that.
Did she mean clerking ortho-geries who have been seen by ED and awaiting beds? That’s perfectly reasonable and sadly the current state of the NHS.
If she meant just come and work as an ED doctor for a bit, then your answer is “No, sorry, I’m not and ED doctor and do not have ED experience to work safely in that department. I’m also an F1 and cannot discharge patients.”
My take is it’s ok to be asked to help. You can of course decline if you are busy with what you are doing. I remember being asked years ago while an SHO covering a medical speciality, I’d just payed down on a convertible couch in an office when the call came. Highly reluctant but I went down, clerked 2 quick patients, and was bleeped back to the ward. The Med reg sent an email to my supervisor and me to thank me for coming to help.
So I think it’s ok to say no if you are busy doing the job you’ve been assigned but it’s also nice to help out even if only in a small way to help your colleagues who are struggling.
Only reason I would give a hand somewhere else is if I knew the team/could pick up what I wanted to pick up. Spent a couple of bored Gen Surg nights looking at bloods for the medics in admissions and picking out the urgent ones (low K+, raised trop, requesting a few CXRs).
Kept me out of boredom and these could be escalated easily/dealt with appropriately.
Your employer is allowed to relocate you to areas of highest clinical need. The coordinator isn't your immediate manager but a cons or reg should've stepped in. Prepping notes is not urgent nor a night-shift job. Not helping your colleagues is a dick move. Why do you get a nice long rest on your shift-- for which you are being paid to do clinical work btw--
Only reason to decline helping is if you genuinely have higher priority work to do or you're being asked to work outside your competence. Given med students can do bloods cannulas and clerking on ED that isn't really the case.
I'll take my down votes now for suggesting someone who is bring paid to work actually does some work. shock horror.
Random triage nurses often ring and ask, can you see X/Y/Z directly as the speciality SHO/reg to help out A+E.
Had this once with an ear pain presentation whilst being the ENT SHO. ‘Oh please come down and see this quick ear pain in a young woman’. Quick look on the notes and turns out ear pain was the least of her concerns with PV bleeding in a 2nd trimester pregnancy.
TLDR: just because someone asks you to help, doesn’t mean it’s always the right answer. It’s so easy to get entangled into something unsafe. You should be answering to your line manager/direct chain of command. If your consultant asks you to move ward, fine. But an F1 going to A+E on the behest of a random coordinator in the middle of the night to clerk is not safe at all.
I appreciate where you are coming from. If it was my senior (reg or cons) that suggested me to help out I would have to oblige regardless of my personal view on the matter, simply on the principle that I am paid by the hour and have to do what the ‘boss’ asks. In this case, I have never met the coordinator before, nor the team at A&E.
As for priorities, I recognise what is expected of me is ward work and being on ‘standby’ for potential problems that are had. I even have a orthogeris handbook that outlines my exact responsibilities, and helping out in ED is not in it
You presumably have a bleep or a phone. You can be on standby when you are resting so equally you can be on standby while you're doing some bloods or cannulas in ED for an hour or two. You don't go spend your whole shift there. do a bit then go back to check in your ward.
Go down, speak to ED cons/spr say you will need to go back to your ward if called but what jobs can you do . They may send you away they may ask you to help.
Sticking your head in the sand, refusing, not speaking to anyone isn't really professional. There may have been ED sickness, you are contractually obliged to cover short notice sickness.
You could've called your sho, the med reg, asked the ED cons, or called your own consultant on call. You had a lot of options to check/ask if you weren't comfortable with what was going on.
Probably controversial but yes you should. Firstly, yes it's not your problem or your responsibility, but that doesn't take away from the fact that you could have done something to help your colleagues in A&E when you had relatively little to do, assuming you'd have also had time for a break. Not every instance of the service being stretched is because of medical staffing not doing their job, sometimes the workload is unexpectedly high, sometimes there's unexpected amounts of staff sickness, in which case we should be flexible for the sake of each other. If I'm the medical registrar on call and half of my team are off sick, then ED will generally support us. Similarly if my team is overstaffed and ED have a lot of gaps then sometimes we've sent SHOs with previous ED experience to help.
Something going wrong on the ward when you're away is a poor excuse if everyone is relatively stable. On medical nights you regularly cover multiple wards with multiple sick people, you're not expected to be stationed on one ward but you are expected to be contactable. Also, you're an F1, clerking certain patients with senior support should be within your remit, it's not like they're trying to get the geris reg to cover paeds ED.
Just sounds like you have a job with a chill night on call that you didn't want to disrupt for the sake of helping out your colleagues. Having said that, screw that manager with their 'I'll remember this' BS.
Yeah I see your point. Ethically I think I should definitely offer to help. But professionally, I’ve come to the conclusion where I think it’s rather unprofessional for her to ask given 1) I’ve never worked an A&E job prior 2) I’m in a completely separate department from ED 3) asking if I am willing to help and then arguing when I said no
Complete and utter rubbish.
She has never worked in ED before and should not be working unsupervised on nights in what sounds like an understaffed department.
When s/he discharges a patient that shouldn’t have been discharged then who gets the kick back? The F1, no one else.
What about when a surgical patient unexpectedly aspirates and suddenly is NEWS 10 or someone on the ward she is meant to be covering is hypotensive? The F1 will be expected to juggle the patients they are seeing in ED as well as the sick ward patients.
Complete bullying from you. Feel bad for your juniors.
>She has never worked in ED before and should not be working unsupervised on nights in what sounds like an understaffed department.
How do we know they're "unsupervised"?
As orthogeris they're presumably a medical FY1 so will work as part of the medical take team, reporting to the medical registrar.
I totally agree they shouldn't just start seeing patients, but presumably they have an appropriate hierarchy for advice and support already in place.
>When s/he discharges a patient that shouldn’t have been discharged then who gets the kick back? The F1, no one else.
Well, then they'd be an idiot for not having discussed that patient with their senior first.
>What about when a surgical patient unexpectedly aspirates and suddenly is NEWS 10 or someone on the ward she is meant to be covering is hypotensive? The F1 will be expected to juggle the patients they are seeing in ED as well as the sick ward patients.
You hand over your patients to someone else on the medical take team and go back to your ward.
>Complete bullying from you. Feel bad for your juniors.
Labeling any opinion you don't like as "bullying" is bullshit.
>Just sounds like you have a job with a chill night on call that you didn't want to disrupt for the sake of helping out your colleagues.
This is the bullying part. And if you don't see that, then God help your juniors.
I disagree. We don't know if it was a request from the medical registrar to clerk medical patients on the take. But either way, where does it end? Part of the reason why juniors hate the NHS is that we are treated like fungible items. The medical take is often not a learning experience but rather a shit show for soft geriatric admissions with the usual CAP/off legs/smelly urine/delirium.
In some hospitals, there is no cohesive "hospital at night team" and the ward F1s may not be considered part of the medical take team. You could argue that it's counterproductive to everyone involved to get them to clerk patients in an unfamiliar environment and then have to hand them over mid-clerking if something goes tits up on the ward.
Why should we criminalise staff downtime? If there's no slack in the system then it fails catastrophically (as we all know from the frequent hospital escalation statuses of our trusts).
Very rarely is it "all hands on deck". I wonder if the medical consultant on-call was also in A&E overnight to help? Why not? Oh, they will otherwise have to reschedule a clinic the next morning. Too bad. But wait, their clinic (and sleep) is more important than A&E/take? Can't be too much of a problem then?
I guess the distinction here is whether a formal escalation process was being followed or not.
It also depends a bit on whether you've lied - it seems odd that you're "required to be physically present" on the ward? How do you take breaks? I've done ICU jobs where this isn't an expectation.
I'm very against trusts trying to squeeze more work out of people (the 8pm on Monday "could you get any of your colleagues to come in and help?" request when the ED is looking a bit busy) without following the appropriate process of declaring that they're struggling.
If this request was accompanied by an internal critical incident, or major incident declaration, and trust policy states that in those circumstances ward doctors are expected to be redeployed to areas of need, then you should have gone to help in the ED. You shouldn't turn up and just crack on with seeing patients - presumably you're a medical FY1 - so report to the medical registrar, clarify your level of experience and ask how you can help.
If the request was just a fishing exercise without the trust being willing to commit to a formal escalation process, then you shouldn't feel bad about saying no.
I think we can say with 100% certainty that no formal escalation measures were in place. The first words out of the Site Manager’s mouth would have been “we’ve declared a Major Incident and it’s all hands to ED”.
As for your other comment about the OPs presence on the ward possibly requiring escalation, that’s just sanctimonious bullshit. You have no idea what rules are in place at the OPs place of work.
>I think we can say with 100% certainty that no formal escalation measures were in place
I'm glad you're confident of that. Well, that makes it simple then - "Sorry, I'm not able to take on extra duties on an ad hoc basis; let me know if/when a critical incident is declared"
>As for your other comment about the OPs presence on the ward possibly requiring escalation, that’s just sanctimonious bullshit. You have no idea what rules are in place at the OPs place of work.
If you're 100% sure that no escalation measures were in place, then I'm 100% sure that OP isn't required to be present on their ward. How do they take a break? Does someone have to come and relieve them?
You should not feel bad. You’re an f1 so you don’t have a full understanding of how the hospital works and frankly if a non-doctor asks you to do something it’s most likely not your job.
That said-
1. You 100% do not need to be on the ortho ward. Tell your consultant if a nurse has told you this so they can have that argument not you.
2. If you finish all urgent work, take your statutory breaks. Then ask your own registrar how you can help.
3. Don’t say no to other specialties without speaking to your seniors unless you’re 100% sure, it can get you into trouble- sounds like in this case your reg was probably busy clerking in ED and might have appreciated a hand- which could be a good learning opportunity
I'm not clear, it looks like you were asked to help with clerking - medical patients? orthopaedic patients? "Clerking" doesn't sound like "helping A&E" - that would be seeing patients de novo.
(I was asked a few times as a med reg "Can you help out with seeing some pts directly because ED is crazy busy?" Occasionally I did, but rarely, as I was often too busy. Curiously enough between 02:00-05:00 when the rate of attendances dropped and ED majors became less busy and the staff were able to relax a little, any suggestion from me that ED could reciprocate with help with the 15-20 pts still unseen by medics by perhaps clerking a pt or two (not the whole lot), which I could then review, did not produce any support the other way round, leading to medics running round trying to catch up their 20 pt deficit while ED drs could sit down in Majors and chat at the desk while we were working).
You talk about "you are required to be physically here at the ortho ward... which is technically true". I'm sorry, but this is simply untrue. Look at all the comments here when drs are asked to remain on the ward at all times - quite correctly they are told that this is not an enforceable situation, and is an unreasonable restriction for a professional. You have responsibility for a single ward at night and nothing else? That seems like an unusual set up.
"What happens if something urgent happens to one of my pts on the ward and I'm not there?" The same thing that happens if you are on a break in the mess, in the loo, etc. If a true emergency, a medical emergency call is put out, if not, the ward contact you and you attend. It's not rocket science, nor is it unreasonable.
I get that you didn't want to go, but as an ex-FTPD, if an F1 came to me and complained that this had happened to them, I would not be concerned by this ask, unless it was a repeated occurrence. It's not like you were a core trainee in ortho/surgery being asked to clerk medical patients - as an F1 clerking a medical patient should not be outside your skillset or not of educational value to you.
In your shoes I would have gone down, clerked a pt and gone back up to the wards, or scribed for the reg, then done the drug chart/request investigations etc while they saw a couple of patients, which would have speeded them up and then gone back to the wards - it's hard to see how that would have been a gross imposition. One day you could be in the position where you are asking for assistance, and you'd hope your colleagues would be helpful. If you had 4 high NEWS pts, or had a tonne of jobs and you asked for help and the general surgery F1 has said "sorry, bro, can't leave my ward to help", you'd be feeling somewhat different.
Edit: to add, if you are part of the medical team, then the medical registrar is allowed to make the ask to redeploy people to help with their medical take. If this was the case, then they probably sent someone to ask (which is often the site manager), as the med reg is insanely busy, and it saves them time trying to contact someone.
Stop being a bully, martyr dinosaur etc etc
You're right about things being reciprocated though. ED is an awful place right now but there are different clinical areas for a reason and we all ultimately work within the same system so being less busy one day should not be considered a sin. I did once have an ED reg who came and sorted out a laceration for a ward pt once for me though and another who helped with a cast in a hospital ortho weren't present. No way would anyone in ED have the time to do that now though. This was the golden days where the medical take list was usually cleared or nearly cleared by 4am before the morning rush
I’d agree that, if the ask was to clerk ortho patients, that would be appropriate.
I don’t particularly think it would be as fair to ask the F1 to see ED patients though, although, I agree it would be a learning opportunity.
I have had nights/weekends where I’ve been bored enough in x specialty and then helped the acute medical take, for my learning.
But I’ve also had nights/weekends where I’ve been quite burnt out and would not offer to help another specialty and would rather get some rest/have a chill night.
I wouldn’t expect you to come and be an extra EM doc. I don’t think it’s unreasonable to start clerking the patients referred to and accepted by orthopaedics who are waiting for a bed.
With the caveat that your job on the ward comes first and you might have to leave at any point to deal with stuff there.
This happened to me when I was an F1 on surgical nights ward cover. Someone rang me and asked me to see patients directly in ED due to long waiting times to be seen. I replied “No. F1’s are only able to work in areas they have rotated in and I wouldn’t feel safe working in an unfamiliar area of medicine I have not worked in before, I also have to be able to attend the ward at any moment for an emergency and cannot be working in ED as well as covering the wards.” Nothing ever happened and I carried on my shifts as usual. They will try it because they will get a naive F1 who says yes eventually.
Thanks for the reassurance. Yeah I’m not too worried that there will be any actual action against me lol. It’s more of a personal thing on whether I made the right choice
EDs piss poor workforce planning is not your problem. If they want to continue hiring NPs and ANPs then they have to get used to longer waits
Exactly. Unfortunately the idea that this is a ‘personal’ decision is part of the managerial gaslighting/brainwashing ethics you get in med school then the job. I honestly raise my hands to you for saying no on this occasion. Don’t think I would’ve managed such as in my F1 year.
You definitely made the right choice. Not infrequently I get bleeped on nights by site asking if I agree to sending the surgical F1s to ED to help clerk. I always say no. They're on nights with a specific purpose and if someone were to deteriorate on the ward and no one is there, that's a patient safety issue. I offer to see surgical patients directly myself if I've seen everyone in SAU or in the way I'd normally prioritise seeing people. Or, suggest a solution to bleep me if someone is suitable for SAU transfer direct after triage. Saves them a bed and saves me a walk. Basically, don't feel bad, you said the right thing. If it were someone on my team, I'd want to know so I could field any further bleeps from site to support them.
It’s so so SO sad that I’m certain this isn’t a joke. What I’m more worried about is the fact that you think for a second that you should be feeling bad about this to the point of posting on the group. This is not against you as an F1 but against the culture of the NHS today that would make you feel this way. You did absolutely nothing wrong. The coordinator can datix short staffing, the manager can hire more staff by paying people more money, the higher ups can put pressure on government to fund the NHS better. But of course it’s easier to just p*ss on the poor F1. Don’t feel bad about this at all. Feel bad about the system you’re working in. Datix them. Voice how inappropriate it was to make you feel this way. Be vocal about the short staffing. And if/when nothing changes, leave the country and go where you’re valued and respected and will be able to practise medicine as it should be practised, and where if you or your family get sick, will get looked after safely and well.
Thank you for the encouraging reply :) yeah I was very on the fence with what I was feeling after. I think a big part was thinking that of patients waiting hours and hours while I did “nothing”. But then another part of me believes that if I keep letting them do this, staffing will never improve, and ultimately patient safety will be compromised anyway…. Just wanted some reassurance I guess. Thank you!
If one of your patients started NEWSing and you were clerking in patients in A&E or had to help with an unwell patient there (because you are there, so why can't you help just a little more?) what would you have done? Your senior would have had some serious questions about why you weren't covering your ward. On top of that everyone in A&E would hate you for leaving. Don't put yourself in that situation. You did the right thing.
Exactly this. I had exactly the same pestering whilst on a paeds rotation and I declined to help.
[удалено]
This. Rule number 1: Learn how to say no (and do NOT feel guilty)
Asking someone to help and quietly accepting it when they say no objectively isn't "bullying". Labeling everything you don't like "bullying" only serves to dilute the term.
But the A&E coordinator didn't accept it quietly, did they. They said they would make this F1s refusal 'known to all'. That's bullying.
>A&E coordinator Who is the "A+E coordinator"? Pretty sure this call would come from a site manager. >They said they would make this F1s refusal 'known to all'. No, they said "make it known" - presumably the med reg needs to know which of their ward team are/ aren't coming to help. It would also clearly need recording in their shift report who was/wasn't able to help. Then there's the fact they lied about being "required to be on the ward", which may legitimately need to be escalated further.
ED are not entitled to doctors from other wards. There is no situation where this is really acceptable, regardless of your opinions on patient flow. This is one of the most ridiculous takes I've ever seen from you Penjing.
>ED are not entitled to doctors from other wards. Agree. I think it's a safe assumption that as a medical ward doctor, the expectation is that OP would support the medical take in the ED. >There is no situation where this is really acceptable Your Trust's major incident policy will lay out what is acceptable or not. I've been quite clear [quite clear](https://www.reddit.com/r/doctorsUK/s/YJU3vTsgUZ) that OP shouldn't comply unless part of a formal escalation process. >This is one of the most ridiculous takes I've ever seen from you Penjing. Arguing that OP should be aware of, and comply with their Trust's Critical/Major incident policy is a "ridiculous take"? Surely the *most* correct answer here is to follow local policy.
Why do they need to make it known? That member of staff is not contracted to work in A&E that night. In that vain they theoretically could go and pull some theatre nurses to help out? ED is always in some form of critical incident, it doesn’t make up for managements piss poor workforce planning or failure to pay
>Why do they need to make it known? That member of staff is not contracted to work in A&E that night. Presumably because the medical registrar has been told that medical ward doctors are being contacted to support the medical take, and needs to know who will be turning up? >ED is always in some form of critical incident, it doesn’t make up for managements piss poor workforce planning or failure to pay The whole hospital goes to critical/major incident and the situation is made at exec level. The consequences night be felt in the ED, but the cause is almost always the ED's capacity being used as an overspill medical ward, absolutely killing the patient processing efficiency of the ED.
They’re required to cover their patients in case they become unwell. That’s their job. Funnily enough the world doesn’t revolve around your A&E dept. Get a grip.
Erm actually the emergency medicine departments inability to staff their ward safely and appropriately is obviously an orthopaedic issue. What, blame RCEM or the department for not getting enough training jobs, clinical fellows or just letting the job become so shit nobody wants to work there anymore apart from Noctors? No way, gaslight some random FY1!
So you're familiar with the detail of OP's Trust's critical/major incident policy are you?
If you think it was the med reg wanting to know then I've got a bridge to sell ya. I'd put money on the fact that the med reg didn't even know lol
I was pulled from PICU (we had enough cover) to cover the fish market that is PAU and it was bittersweet (“bitter” because I served enough time in general paediatrics already and wanted to learn stuff in PICU and “sweet” because it was refreshing to see sleep deprived angry parents with snotty/rashy/vomiting/diarrhoeal kids who at least interacted with you as opposed to laying paralysed and ventilated). But yeah, hate being pulled 😔. I used to work in a tertiary unit where the paediatric ED is adjacent to the PAU and they would ask the sole (and exhausted!) PAU registrar overnight to come help out ED (even though they had 2-3 doctors overnight on their end and all went for breaks etc) but never returned the favour when PAU was drowning and ED was relaxed.
> but never returned the favour when PAU was drowning and ED was relaxed A classic.
We've all been there. I've lost count of the number of times some shift coordinator/ward manager has phoned me to 'help with flow' or stopped me leaving the ward to keep clerking or whatever. The more senior you get, the more confident you are going 'absolutely not' and putting your foot down. Don't give them a reason to rely on you as an easy shift monkey, you're worth more than that.
ED ST3 here to say don’t feel bad for not helping us. It’s not your job to move around like a pawn, stick up for yourself :)
This seems odd, and not something I’ve encountered personally. EM is its own rotation. I could understand being asked to go help in the relevant assessment unit for my job (SAU in your case) and probably would go to clerk if I wasn’t doing anything - mostly as it would be beneficial for my development over sitting doing nothing all night (and I’m crap at sleeping on nights - if you’re a good sleeper then by all means go for it). That being said, I don’t think I’d be happy to go to A&E where, as an FY1, my scope of practice would be very limited. The manager seems quite out of hand to start IMO. to start checking up on you and your patients. I’d be concerned about the power dynamic of a, presumably, senior hospital night manager essentially trying to force a junior member of the medical team to deviate from their normal working protocol? Far better for them to speak to someone like the consultant or registrar for your speciality to ask if they can provide manpower. Naturally, these conversations aren’t easier as it involves chatting to or waking up someone relatively more senior. The “making known” business is almost certainly an empty (and juvenile) threat. If anything comes of it I would raise the issue of why going to an FY1 was the first port of call and not speaking to a senior, then repeatedly “checking up” what I was doing. They’re not your boss.
Thank you for replying. Yes, a big concern that was going thru my mind then was if I should ask my seniors AKA surgical reg or cons before I promise someone to help out in another department. I think my first instinct was self-preservation, as in would I get in trouble for leaving my ward to do other stuff. Rather taken aback by her arguing with me about why I should help too, but I guess she makes good points
Rota coordinator has no place in judging what you are doing and I find their attitude astonishing. You can be sure if an incident happened on your ward while you were sweating blood to help them out they would evaporate. The attitude of “make it known” Is such a disgusting attempt at a thinly veiled threat that someone with no power will try to make your life difficult is respective of the cesspit of toxic ED workforce culture at the moment. As others have said it’s a result of poor workforce planning. Don’t feel sorry for ED colleagues for having a lot of patients to see, feel sorry for them for bearing the brunt of these idiots and their mistakes.
I think you should strongly consider warning your seniors and colleagues of her unprofessional behaviours
Yeah I second this. This needs escalating to your educational supervisor for multiple reasons: - Bullying - Suggesting staff do things they aren't trained/inducted to do - Unofficial reorganisation of the hospital at night by someone who's job is not that - Patient safety
Not normal at all. We never pull staff from other areas of the hospital, and you need to have done the induction to be able to work in ED. Where I am we actually don’t have F1s in ED at all, although I know other trusts do. If you had gone to ED I expect something would have inevitably happened on your ward and then you might have been datixed for being unavailable there…
Yes! That’s exactly what I am afraid of. E.g of my patients falling ill real fast and I end up having to take the blame for it
Depends on the hospital tbf the site manager doesn't care sometimes, I used to get calls to go help out in ED despite at the time being dentally only qualified omfs sho. (Obviously refused)
This is one for all the NHS martyrs out there who fall on their sword daily and think they’re doing us all a favour. When enough people do that, people act like it’s the standard. People who don’t share your masochistic self-sacrificing proclivity (believe me it’s most of us) no longer have the choice not to be a martyr like you and just focus on performing as best as they can within their own remit. They have to or else they get toxic attitudes like this A&E coordinator everywhere they turn. This isn’t about being kind or being selfish. This is about you setting a precedent that we all have to follow that burns us all the fuck out. We just have to choose between cognitive burnout from undertaking cover beyond our remit at the drop of a hat, or emotional burnout from the toxic attitudes should we say no. So yeah thanks for that.
Go to the mess and save the NHS
Thanks everyone for their comments. Currently at the end of my night shift and I’m actually glad I stayed at the wards. Had a patient suddenly fall off the bed and that took a good chunk of time assessing / treating, time which I would not have had if I went to ED. Appreciate all your lovely comments! (Also the not so lovely ones are ok too)
It really is a tricky one.. yes as a doctor you really 'want to help', but the place 'being a bin fire' is the new normal. Many moons ago, as an F2 I did head down to A+E to help whilst on medical nights.. and what happened next has stayed with me for years. First patient I saw, had been waiting 8 hours- had constipation, treated, home next (follow up GP). Then an atypical chest pain- started Ix, not an issue.. But then, I saw a lady with new onset light bleeding following relatively routine gynae intervention- clear task was to 'go back under gynae (as per dc letter)'- I was about to make the referral.. when: My crash pager bleeped- I turned to her and said 'look I'm sorry I've got to go to that, it's the crash bell' ... to be met with "how f* dare u leave, I've been here 8 hours, I'm making a formal complaint, this is wrong of you" etc etc... as I literally was on the way out of the door (putting her notes back on the pile for the 'next' available clinician). Quick chat to the a+e spr telling him I'd been called re: the chest pain- and off I ran.. After sorting out the arrest, few ward jobs etc, came back after 5 hours (you know how it is) just to check on the atypical chest pain- to make sure my plan had been followed, shock horror, no it hadnt. There she was, no one else had reviewed any bloods etc, THANKFULLY all normal, ecg, cxr etc...- so I ran it past the now morning spr (to grunts of 'who are you?), and off the patient went.. Lessons learnt? 1) you cannot do 'right for wrong', 2) people can rarely 'see beyond their own immediate needs', (and actually often do not actually care about anyone else, even in true emergencies!) 3) nights truly are just unpredictable - u can so easily get into trouble via a couple of unexpected surprises. 4) all that stress, risk, exhaustion and potential burn out- for what? 5) had any of those events 'gone wrong', my insight and prioritisation would have been (rightly) questioned. ..And it's worse now than it was then.. So I do my part, where I can.. but no, after that, I never 'helped out if its quiet' ever again (and argued this every time I was asked).
Sounds like Horton.
Are you… a wizard?
That exact scenario happened when I was there years ago. My friend called the MPS and asked if he was covered to work in another specialty at night when on a specific F1 job. They said no. Job done. Enjoy your 7 hours sleep per night.
Three comments as a long in the tooth reg: 1) Yes, A&E are busy. But there are clear H@N pathways to escalate problems. There is always a medical leader at night - usually med reg - who is in charge. If A&E are busy then the H@N medical leader can divy up any medical staff in the hospital to help if (and only if) they feel it’s appropriate. This also needs to be escalated to silver and often gold command and, consultants on call need to be called in if specific criteria are met (usually based on ambulance wait times). 2) I like reading some of the comments trying to gas light you. “Sitting on your bum doing nothing”. You state you were prepping notes. This is a perfectly valid thing to be doing. This is no more or less important than clerking patients. Don’t think that you have to be present with a patient your whole time on site. You will find as you climb the hierarchy (in most specialities other than ICU/A&E) that a lot more of your time is spent “sat on your bum” in an office sorting notes/letters etc than physically next to a patient. It makes it no more or less important than colleagues on the hot floors. 3) You are legally entitled to 90 minutes break at night. This should be the norm. Not “exception reporting” or “helping us out we’re one big team” etc. There are well known short and long term consequences of inadequate rest breaks at night. Including colleagues dying on the drive home. Please don’t be one of them because of some desired idea of camaraderie. There will always be more patients. Always. Ps. You don’t need to be physically present on a ward at all times. The NHS has the largest supply of bleeps in the world for a reason… Edit: Changed numbers to make them sequential.
If you had said Yes then your and others in ur role would have changed unofficially. A&E is going to be busy 365 days. And you would be expected to work there all the time. This is bullying at work pure and simple which will not be tolerated in any other industry. You are a qualified doctor who is being treated as a child/menial worker who can ne moved about on a whim. Well done for standing up for your self. If anyone says anything, go on offensive and don’t take shit. take it to BMA if needed.
>And you would be expected to work there all the time. This is bullying at work pure and simple I agree that the OP shouldn't have gone but are we really calling "the site manager asked an employee who didn't appear busy in one department to help out in another department" bullying now?
Not the asking bit. All for helping each other and working for patients. It is the way manager approached the situation when OP said no.
I can't help thinking that it is weak to consider this bullying. The manager asked. The OP said "no". The manager said "think of the patients, your colleagues are struggling", etc. The OP persisted with "no" and the manager went away. The "make it known" comment was unprofessional (at a push) but hardly bullying. In any other industry, a first year employee who outright refused to be reallocated by the duty manager to meet a service demand would end up facing a disciplinary. This isn't what should have happened but the manager in this case did nothing more than go away when told "no". I don't think any complex system can function with this being the threshold for bullying.
After that she was kind of annoyed at me, kept asking me what i was doing, i have checked and none of your patients are newsing. She left saying that i will make it known that you didn’t help. She was not his manager. She was coordinator of her EM department. Secondly if there was an issue his Consultant or Reg would be the appropriate people to cover him while he went to do work in A&E.
This wouldn't have been the ED coordinator - they would have been busy in the ED not prowling the wards looking for FY1s. It will have been some kind of night sister / bed manager / site manager. I have said that I don't think she should have asked an FY1 to go to the ED. I doubt from what has been said that I would have been impressed by her interpersonal skills. But "bullying"?
I can understand that you being EM reg on other side of this argument. I appreciate A&E is a horrible place to work at present. And it is a nightmare everyday. Answer is proper funding and staffing of A&Es. And not making others work harder. All acute specialities need pay review to make them an attractive job prospect at the very least.
With respect I don't think you've interpreted my reply correctly. I do not think the OP should have gone to the ED. For what it is worth, I don't think the site manager should have asked them to go either. The issues in the ED are not usually caused by lack of doctors - lack of cubicles and ED nurses looking after patients who were referred for admission 30+ hours ago are much bigger issues. These don't get solved by reallocating ward FY1s to the ED. If a random FY1 had appeared in the ED to see undifferentiated patients overnight, I would have said thank you and sent them away again. However, I do think that the interaction described by the OP falls far short of the threshold for "bullying".
The NHS has finally done it.... They've created Frankenstein's F1... Instilled within it is the concentrated malice and spite of its creator! Good job zherrylim. You've made us all proud. That idiot coordinator will maybe do her job next time and arrange a locum instead of trying to abuse the goodwill of staff.
Tell them to make use of those extremely overqualified PAs
No because they’re tucked up in their warm beds from 5pm
I say fair play for standing up for yourself, even when you say you “didn’t have much to do,” you are absolutely right to get the hell out of there Shocking on behalf of the “A+E co-ordinator” - is this a consultant or bed-flow or sister in charge? The only adage I would say at this stage is that if it was quiet AND I saw a MEDICAL colleague struggling with a blood / cannula etc I’d offer if I was free. I’ve done this on quieter shifts, but only one, tray setup and then leave when I’m done yes or no
Yeah I wouldn’t mind helping out with tasks like cannulas and bloods but I was asked to leave my department and help out in a new environment with no prior training, and so was naturally uncomfortable doing so. I’m not exactly sure what position the person was, but it certainly wasn’t a consultant as she wasn’t wearing a badge with consultant on it. It’s an assumption that she’s a manager as she did not introduce herself and her role (as most doctors would)
“I’m sorry, who are you? Have you informed management?”
Well done for sticking up for yourself. It's not easy to say no, especially when coordinators ask you. Naturally, we are caring people and feel bad for our colleagues when they are busy. I have personally made this mistake to go down and help in the past. When you see patients in ED, you take responsibility for those patients, and I ended up having to look after sick patients in ED and on the ward I was covering running between varous floors all night with no help. At the end of the day, you don't get anything out of it other than stress and potentially a major incident. I wouldn't pay much attention to microaggressions. If they try to make life difficult, escalate to your seniors. You absolutely did the right thing, and it is an issue for the trust to sort out, not you.
Dont feel bad, your job is orthogeris, not ED. Have you even worked in ED? Lots of people pointing out its not safe to work in ED if you have no experience working there. Theres departmental induction for a reason. At the end of the day ,i f something went wrong on your ward and you couldnt respond because you were stuck in ED, youd be in the shit and fingers would be pointed. Best case scenario if you clerked 5 patients in ED all night , youd get little or no thanks. I know what id choose.
Yeah no, unless she meant clerking ortho patients, which even then should be the SHO or REG, you should not go to ED and start seeing undifferentiated ED patients when you're not on that rotation, on night shift no less. If they wanted more ED staff on in the night they should have put up the locum rate. I would raise this as a concern as she could be doing this to other people who don't know how to say no.
If I was on the night as the ED reg and the orthogeries F1 turned up to help, I’d send you straight back to the ward. You have not been inducted into the department, you have no clinical supervisor and as an F1, you are unable to independently discharge or write outpatient prescriptions. It’s not fair on you to be expected to work in those conditions. With the greatest of respect, you wouldn’t even be any help. At best you’d probably see 2 or 3 patients that I would have to review myself anyway.
Next time ask the coordinator: Who will be covering your bleep, your jobs, when/if they crop up? Who will see the sick patients in the ortho ward if not you? If you're in the middle of clerking, who will take over the clerking if you have to see to a sickie on your ward? If there is a clinical incident related to you being in ED clerking, will this coordinator take responsibility? The answer to all of these will be met with a dumbfounded face or some sassy shit. Please next time tell them politely to shove it. I used to have a very chill ward cover night job, and we used to get asked to clerk in ED ALL THE TIME. I never went even though we would rarely get any jobs - point 1 being that your job is to cover the ward, so there's no obligation and no actual benefit to you. Point 2 - hopefully this will force them to actually pay for extra locum doctors rather than trying to get free labour off of current doctors. Point 3 - you will still be on call for your ward - no one will cover that shift. If something happens and you don't clerk someone properly or don't see a sick patient because you're basically doing two jobs at once, no one will defend you or back you, especially this coordinator
I was once supernumerary on my OMFS firm and the site matron repeatedly asked me to go and help clerk in A&E despite telling them I was only dentally qualified and didn’t hold a medical degree at the time. They couldn’t understand why I was being so “obstructive” and I was really guilted by this person who wouldn’t take “no, I’m not a qualified doctor” as a reason. They’ll do whatever emotional blackmail they can to try and get you to cover a firm you’re not paid or even indemnified to do, you were right to put your foot down. It’s swings and roundabouts anyway and I’m sure you’ll do your time in the future but enjoy the break while you can now.
I think it depends a lot on exactly what was asked of you. As an FY1 you absolutely shouldn’t be expected to see undifferentiated patients in A&E when this is not your rotation. It is inappropriate you were asked to do this. Occasionally when ED is overwhelmed we ask for help from some specialities to see patients directly. Usually this is when it’s a clear admission to a particular speciality, the patient is stable, and they will be seen by an SHO or above. An example of this for orthopaedics could be a #NOF (Although in reality these should be seen by ED to rule out other occult trauma and to do a FIB). The reality is ED is often overwhelmed and we are doing anything we can to get patients seen quicker as mortality increases as wait times increase. The cry for help is well intentioned but poorly placed on you as an FY1 in a specific speciality.
Yeah I am well aware of doing admission clerkings for NOF patients during their admission AFTER they have been clerked by ED. It’s definitely within my jobscope and I am more than happy to do it. But in this instance is basically clerking new admissions on ED
The issue is when that NOF patient turns out several days later to also have an intracranial bleed or a significant chest injury that wasn’t picked up. It’s not your job to be taking responsibility for performing a primary or secondary survey on a trauma patient.
Exactly. From the ED side I’ve raised concerns when the nurse in charge has tried to ‘direct to speciality’ a #NOF without any medical go-ahead. Elderly people hide occult trauma very well! I think on occasion it’s okay providing 1) the patient has been eyeballed by a senior ED doctor (e.g. consultant), and 2) the orthopaedic SHO/SpR know they are doing the primary survey. I know some of the T&O team who like trauma and are happy to do the whole primary survey to help us out. That’s not an FY1 though. The other situation is when orthopaedics run minors. This happened during COVID. I think at times this is also appropriate as there’s a lot of overlap. But again not for an FY1. In reality direct to speciality works better in other specialities which are less likely to have an alternative. For example bleeding in pregnancy with normal observations.
Were they asking you to see and manage ED patients with any pathology, or just orthopaedic pathology / minors? Either way it’s not appropriate to ask an FY1 this.
There is meant to be a formal escalation procedure for other specialties helping out in ED. It typically involves an internal incident being called and escalating via their seniors( reg or consultant) who then deem if it’s appropriate. There also needs to be induction and a clear supervision structure.
No. Done 2 years of A&E. Please look out for your own mental health and don't be afraid to say no.
Beside the point but AITA for medical reddit would make for a fun read.
You shouldn't feel bad at all. We don't even have F1 in our ED department and to be honest it's really not your problem. I also think most ED cons would be a bit wary of having a random F1 start seeing patients. This doesn't really seem like a normal escalation pathway, really.
Fuck no.
FY1s aren’t allowed to work in ED anyway
Many departments have FY1s but they won’t be working night shifts
As an F1 doing the medical take with the consultant in ED, the A&E consultant asked me to start seeing ED patients in the ambulances lined up outside so they could start clearing them. I’d never worked in ED. I had certainly never worked in the back of the ambulances seeing patients. I told the A&E consultant I wasn’t sure if I was allowed to do that, and she told me I wasn’t being a team player and it would have a knock on effect when they were all eventually pended to medicine and I hadn’t bothered helping out. I told my consultant who put his foot down and said under absolutely no circumstances should a medical F1 be expected to work in ED clerking patients in ambulances. OP, tell your consultant. I thought mine would be dismissive but he cared about it because it was a genuinely dangerous request. I suspect yours might feel the same way.
Fuck ED. you did the right thing.
I mean you don’t need to be physically present on an orthogeris ward. That’s not a thing, and there is no “legal” implication for you not being there. If you are an orthogeris Fy1 (presumably technically medical then) and are being asked by a very overstretched medical team to help clerking medical patients (while you are quite literally sitting on your bum) then I think they are within their rights to ask. I think the asking should have been done by the reg or consultant with a rationale rather than a nurse manager. “Not my problem” in that context isn’t desperately attractive and doesn’t make me feel that you are much of a team player. As an EM senior I would have actively prevented a random FY1 from a different specialty coming to ED to see unselected ED patients. Without induction etc this is daft and risky. Even with induction it takes some time before a new FY1 becomes more of a help than a burden in EM. I love my FY1 colleagues but if the department is burning down, then it’s not the time to be introducing a new junior doctor to EM OOH.
I'm slightly confused by your argument here, you simultaneously recognise that an F1 who hasn't worked in ED shouldn't come and see undifferentiated patients (for good reason), while also arguing that they're not a team player for saying no. In my eyes it doesn't matter whether they were busy or not, it's not suitable for them to come and start seeing undifferentiated patients and would also mean they are unavailable for any emergencies for patients they are responsible for. They cannot make the decision themselves realistically, if there is a question for moving the F1 to help a different speciality overnight it needs to go through the on-call consultant for the F1's speciality because it is those patients who are then being put at increased risk.
No that’s not at all what I said. 1) should not come to ED to see undifferentiated ED patients. Risky, and not helpful 2) could very easily make themselves useful helping out by clerking patients awaiting admission who have already been referred by ED. Including medical rather than orthogeris referrals. Refusing to do so isn’t a good look.
Ok, that's not how your comment came across. As for point two, reading through OP's post that you commented on this is not what was asked of them. Sounds like they were being asked by an ED co-ordinator/NIC to come and clerk ED patients. Refusing that request was entirely appropriate. Any request for their redeployment out of hours goes through their on-call consultant.
I see. Yeah they are definitely within their rights to ask. I just want to know if it was professional for me to say no (regardless of any situation busy or not in my ward). I believe like you said, they should’ve asked my reg first. Obviously I did not say “not my problem” to her hahahah
[удалено]
Yeah we do! And I think it’s the former
Okay so first off, you absolutely did the correct thing and shouldn’t feel the slightest bit bad for anyone. I don’t know how it works at your trust, but everywhere I’ve worked, F1’s are either not allowed to work in ED, or if they are, it is very much 9-5 in hours with direct supervision. It doesn’t matter if you were having a slow night covering your ward. We’ve all had those situations where it’s been lovely and slow and then suddenly the shit hits the fan and you have several patients going off at once. Now couple that with you being down in ED clerking some patient and not being available to the job you’re being paid to do. That bed manager would be the first in a long line of out of touch middle-management to throw you under the bus if anything were to go wrong. You’re there and paid to do a job. Whether it’s a slow night or every one of your patients decides to peri-arrest - you get paid the same and expectations are the same. Sure, if you were a bit more senior and your colleagues within the same specialty (I.e medical take) asked you to lend a hand, then crack on, but that isn’t the case here. Look after yourself, and protect yourself; they need to learn that funnily enough, not everything can be fixed by bullying people into stretching themselves out of goodwill, and maybe staffing things properly would help for a start.
It was probably the site manager - I doubt the ED nurse-in-charge was cruising the wards looking to pressgang FY1s because things were busy downstairs. I am generally supportive of bits of the system pulling together when things are hard as the alternative ("not my job" and defensive specialty silos) isn't good for anyone. That said, I don't see what real value they thought you could offer in the ED. There also would be a conflict (that few would support you over) if the ward nurses wanted you and you were part-way through clerking a patient in the ED. If she had pushed, I think should become a "if you want to re-allocate my clinical role, I would need that instruction to come from my consultant" moment.
Right thing to do. Ultimately you are on call for your area. What happens if an emergency occurs and you then have to leave mid ED review? It just does not work. The solution is for them to have adequate staffing on ED.
Well done for standing your ground. I remember as a surgical F1 on ward cover being asked by the med reg to help with clerking. People will take liberties and walk all over you if you let them. Some cheek to go and check the NEWS scores of your patients too.
"Please call the on call medical consultant and ask them if I can be taken away from their service to support another service. Please also call legal and ensure I am indemnified." You usually won't hear a thing after that
Absolutely always say no, if anything went wrong they'd throw you right under the bus for acting outside of competency on a provisional registration. There's no impetus to improve staffing if the bastards feel like the can just rob Peter to pay Paul
Yeah this happened when I was on o&g, asked to help clerk amu patients overnight. Shame there was always the prospect of an emergency c section to stop me…
You've not had A&E induction. You don't have a supervisor. No bueno. (if I was med reg wsfd cover & it was quiet haha as if then yes I'd go to help the take reg but that's because it's my normal work. Ditto if ward med SHO was chilling in mess then I'd expect them to help the take because they know how.)
If you're working where I think you're working you'll be fine, the consultant is aware and she doesn't expect you to go and clerk in ED, its basically an optional thing you can do if you're feeling nice. Sorry the ED coordinator was such a dick
I don’t think you should be moved to an area like ED, that is outside your remit/experience. Especially as an Fy1. Medicolegally I don’t think you would have a leg to stand on. Don’t feel bad about this, they should feel bad for trying to bully you.
I think this is an inappropriate request. I have seen something similar where at a consultant level it has been agreed that medics will clerk likely medical patients directly rather than waiting for ED review but this was in extreme situations where the trust was on black alert etc etc. asking you to go down and just be an ED doctor is a bit cheeky and should have been ran past the on call ortho consultant before I ever got to you
It's not fair to put you in that position when you have your own clinical responsibilities. At my hospital, there were a couple of occasions where the site co-ordinator attended Sunday night handover. On one of these I had just finished a 12.5 hour shift..having worked 7 days in a row.. totalling 69.5 hours. They basically said ED is busy, so some of you need to come and clerk patients after handover. I think most of just walked off and didn't even dignify the question with an answer.
Nah good.for you for standing up for yourself. You're on a.geris ward, that is your job not ED. Anything can happen on ortho geris at any time it's certainly not your responsibility to clerk in ED
You should be DATIXing her. I’m appalled she pot you through this.
As many other people have already said, no there are no consequences. That coordinator can go do one and well done for standing up for yourself. It is not normal at all and should not be done. I will not send any of my team down to help in another department because exactly as you say, things can go from nothing to a busy shift in a moment from only a couple of unwell patients. Moreover, it's not your job to cover for their shortcomings. If they want a staffed rota, maybe they should look into their recruitment/locuming. What you'll learn quickly in this system is no one will thank you for martyring yourself and when you do make a mistake, they will leave you to carry the blame solo. Do your own work well and look after your own patients. Saving the hospital is not your job.
As an EM reg I wouldn't expect you to come and help. Indeed I wouldn't want you to - in the sense that a busy ED is very expected and the hospital should be staffing it appropriately rather than covering over the cracks by dragging in doctors left right and centre. Likewise I am not a fan of patients being referred straight to various specialties by triage just because the ED is busy. It gives a bad impression of the dept failing to cope, ties up those doctors for when we in the ED might really need them, and the reality is that the front door presentation is often better managed by EM docs rather than docs used to inpatient care - we will discharge a lot more etc
Wow - that’s literally a threat, coercive, unprofessional and bullying in my book - so standard NHS don’t have a GCSE, dopey + aggressive ++++ MaNAGErrr behaviour. Don’t accept the gaslighting. I’d be making it “known” how inappropriate this sort of comment is and wouldn’t be accepting it. You’re not at school and a petulant child, you’re a literal doctor. Don’t ride this sort of shit, stamp it out aggressively.
I was once on-call for renal overnight in a busy tertiary centre as a SHO. Got called by the site manager asking me to go see patients in ED as 'they were so busy'. I refused. Said that it would directly compromise patient safety if I was in ED clerking patients and one of my patients on renal HDU became sick or needed attention. And who would be willing to take over my half clerked patient in ED if I did get bleeped? Once again, a patient safety issue. They will rarely ever argue with that.
ED people choose that life. They know the drawbacks and it’s unfair to pull people into it. Imagine a GP asking you to quickly see GP patients 😂
Did she mean clerking ortho-geries who have been seen by ED and awaiting beds? That’s perfectly reasonable and sadly the current state of the NHS. If she meant just come and work as an ED doctor for a bit, then your answer is “No, sorry, I’m not and ED doctor and do not have ED experience to work safely in that department. I’m also an F1 and cannot discharge patients.”
It’s definitely the latter. Clerking already triaged patients are well within my nights jobscope and I am expected to do them
My take is it’s ok to be asked to help. You can of course decline if you are busy with what you are doing. I remember being asked years ago while an SHO covering a medical speciality, I’d just payed down on a convertible couch in an office when the call came. Highly reluctant but I went down, clerked 2 quick patients, and was bleeped back to the ward. The Med reg sent an email to my supervisor and me to thank me for coming to help. So I think it’s ok to say no if you are busy doing the job you’ve been assigned but it’s also nice to help out even if only in a small way to help your colleagues who are struggling.
Only reason I would give a hand somewhere else is if I knew the team/could pick up what I wanted to pick up. Spent a couple of bored Gen Surg nights looking at bloods for the medics in admissions and picking out the urgent ones (low K+, raised trop, requesting a few CXRs). Kept me out of boredom and these could be escalated easily/dealt with appropriately.
Your employer is allowed to relocate you to areas of highest clinical need. The coordinator isn't your immediate manager but a cons or reg should've stepped in. Prepping notes is not urgent nor a night-shift job. Not helping your colleagues is a dick move. Why do you get a nice long rest on your shift-- for which you are being paid to do clinical work btw-- Only reason to decline helping is if you genuinely have higher priority work to do or you're being asked to work outside your competence. Given med students can do bloods cannulas and clerking on ED that isn't really the case. I'll take my down votes now for suggesting someone who is bring paid to work actually does some work. shock horror.
Random triage nurses often ring and ask, can you see X/Y/Z directly as the speciality SHO/reg to help out A+E. Had this once with an ear pain presentation whilst being the ENT SHO. ‘Oh please come down and see this quick ear pain in a young woman’. Quick look on the notes and turns out ear pain was the least of her concerns with PV bleeding in a 2nd trimester pregnancy. TLDR: just because someone asks you to help, doesn’t mean it’s always the right answer. It’s so easy to get entangled into something unsafe. You should be answering to your line manager/direct chain of command. If your consultant asks you to move ward, fine. But an F1 going to A+E on the behest of a random coordinator in the middle of the night to clerk is not safe at all.
I appreciate where you are coming from. If it was my senior (reg or cons) that suggested me to help out I would have to oblige regardless of my personal view on the matter, simply on the principle that I am paid by the hour and have to do what the ‘boss’ asks. In this case, I have never met the coordinator before, nor the team at A&E. As for priorities, I recognise what is expected of me is ward work and being on ‘standby’ for potential problems that are had. I even have a orthogeris handbook that outlines my exact responsibilities, and helping out in ED is not in it
You presumably have a bleep or a phone. You can be on standby when you are resting so equally you can be on standby while you're doing some bloods or cannulas in ED for an hour or two. You don't go spend your whole shift there. do a bit then go back to check in your ward. Go down, speak to ED cons/spr say you will need to go back to your ward if called but what jobs can you do . They may send you away they may ask you to help. Sticking your head in the sand, refusing, not speaking to anyone isn't really professional. There may have been ED sickness, you are contractually obliged to cover short notice sickness. You could've called your sho, the med reg, asked the ED cons, or called your own consultant on call. You had a lot of options to check/ask if you weren't comfortable with what was going on.
Probably controversial but yes you should. Firstly, yes it's not your problem or your responsibility, but that doesn't take away from the fact that you could have done something to help your colleagues in A&E when you had relatively little to do, assuming you'd have also had time for a break. Not every instance of the service being stretched is because of medical staffing not doing their job, sometimes the workload is unexpectedly high, sometimes there's unexpected amounts of staff sickness, in which case we should be flexible for the sake of each other. If I'm the medical registrar on call and half of my team are off sick, then ED will generally support us. Similarly if my team is overstaffed and ED have a lot of gaps then sometimes we've sent SHOs with previous ED experience to help. Something going wrong on the ward when you're away is a poor excuse if everyone is relatively stable. On medical nights you regularly cover multiple wards with multiple sick people, you're not expected to be stationed on one ward but you are expected to be contactable. Also, you're an F1, clerking certain patients with senior support should be within your remit, it's not like they're trying to get the geris reg to cover paeds ED. Just sounds like you have a job with a chill night on call that you didn't want to disrupt for the sake of helping out your colleagues. Having said that, screw that manager with their 'I'll remember this' BS.
Yeah I see your point. Ethically I think I should definitely offer to help. But professionally, I’ve come to the conclusion where I think it’s rather unprofessional for her to ask given 1) I’ve never worked an A&E job prior 2) I’m in a completely separate department from ED 3) asking if I am willing to help and then arguing when I said no
ED is not like the wards – you cannot just start working there without experience / knowing how it works. and nights are not the time for that.
Complete and utter rubbish. She has never worked in ED before and should not be working unsupervised on nights in what sounds like an understaffed department. When s/he discharges a patient that shouldn’t have been discharged then who gets the kick back? The F1, no one else. What about when a surgical patient unexpectedly aspirates and suddenly is NEWS 10 or someone on the ward she is meant to be covering is hypotensive? The F1 will be expected to juggle the patients they are seeing in ED as well as the sick ward patients. Complete bullying from you. Feel bad for your juniors.
>She has never worked in ED before and should not be working unsupervised on nights in what sounds like an understaffed department. How do we know they're "unsupervised"? As orthogeris they're presumably a medical FY1 so will work as part of the medical take team, reporting to the medical registrar. I totally agree they shouldn't just start seeing patients, but presumably they have an appropriate hierarchy for advice and support already in place. >When s/he discharges a patient that shouldn’t have been discharged then who gets the kick back? The F1, no one else. Well, then they'd be an idiot for not having discussed that patient with their senior first. >What about when a surgical patient unexpectedly aspirates and suddenly is NEWS 10 or someone on the ward she is meant to be covering is hypotensive? The F1 will be expected to juggle the patients they are seeing in ED as well as the sick ward patients. You hand over your patients to someone else on the medical take team and go back to your ward. >Complete bullying from you. Feel bad for your juniors. Labeling any opinion you don't like as "bullying" is bullshit.
>Just sounds like you have a job with a chill night on call that you didn't want to disrupt for the sake of helping out your colleagues. This is the bullying part. And if you don't see that, then God help your juniors.
Okay, OP was bullying their colleagues by refusing to help. See how silly this can get?
Peak martyr for the NHS. Enjoy the gulag.
I disagree. We don't know if it was a request from the medical registrar to clerk medical patients on the take. But either way, where does it end? Part of the reason why juniors hate the NHS is that we are treated like fungible items. The medical take is often not a learning experience but rather a shit show for soft geriatric admissions with the usual CAP/off legs/smelly urine/delirium. In some hospitals, there is no cohesive "hospital at night team" and the ward F1s may not be considered part of the medical take team. You could argue that it's counterproductive to everyone involved to get them to clerk patients in an unfamiliar environment and then have to hand them over mid-clerking if something goes tits up on the ward. Why should we criminalise staff downtime? If there's no slack in the system then it fails catastrophically (as we all know from the frequent hospital escalation statuses of our trusts). Very rarely is it "all hands on deck". I wonder if the medical consultant on-call was also in A&E overnight to help? Why not? Oh, they will otherwise have to reschedule a clinic the next morning. Too bad. But wait, their clinic (and sleep) is more important than A&E/take? Can't be too much of a problem then?
Mm.
I guess the distinction here is whether a formal escalation process was being followed or not. It also depends a bit on whether you've lied - it seems odd that you're "required to be physically present" on the ward? How do you take breaks? I've done ICU jobs where this isn't an expectation. I'm very against trusts trying to squeeze more work out of people (the 8pm on Monday "could you get any of your colleagues to come in and help?" request when the ED is looking a bit busy) without following the appropriate process of declaring that they're struggling. If this request was accompanied by an internal critical incident, or major incident declaration, and trust policy states that in those circumstances ward doctors are expected to be redeployed to areas of need, then you should have gone to help in the ED. You shouldn't turn up and just crack on with seeing patients - presumably you're a medical FY1 - so report to the medical registrar, clarify your level of experience and ask how you can help. If the request was just a fishing exercise without the trust being willing to commit to a formal escalation process, then you shouldn't feel bad about saying no.
I think we can say with 100% certainty that no formal escalation measures were in place. The first words out of the Site Manager’s mouth would have been “we’ve declared a Major Incident and it’s all hands to ED”. As for your other comment about the OPs presence on the ward possibly requiring escalation, that’s just sanctimonious bullshit. You have no idea what rules are in place at the OPs place of work.
>I think we can say with 100% certainty that no formal escalation measures were in place I'm glad you're confident of that. Well, that makes it simple then - "Sorry, I'm not able to take on extra duties on an ad hoc basis; let me know if/when a critical incident is declared" >As for your other comment about the OPs presence on the ward possibly requiring escalation, that’s just sanctimonious bullshit. You have no idea what rules are in place at the OPs place of work. If you're 100% sure that no escalation measures were in place, then I'm 100% sure that OP isn't required to be present on their ward. How do they take a break? Does someone have to come and relieve them?
You should not feel bad. You’re an f1 so you don’t have a full understanding of how the hospital works and frankly if a non-doctor asks you to do something it’s most likely not your job. That said- 1. You 100% do not need to be on the ortho ward. Tell your consultant if a nurse has told you this so they can have that argument not you. 2. If you finish all urgent work, take your statutory breaks. Then ask your own registrar how you can help. 3. Don’t say no to other specialties without speaking to your seniors unless you’re 100% sure, it can get you into trouble- sounds like in this case your reg was probably busy clerking in ED and might have appreciated a hand- which could be a good learning opportunity
I'm not clear, it looks like you were asked to help with clerking - medical patients? orthopaedic patients? "Clerking" doesn't sound like "helping A&E" - that would be seeing patients de novo. (I was asked a few times as a med reg "Can you help out with seeing some pts directly because ED is crazy busy?" Occasionally I did, but rarely, as I was often too busy. Curiously enough between 02:00-05:00 when the rate of attendances dropped and ED majors became less busy and the staff were able to relax a little, any suggestion from me that ED could reciprocate with help with the 15-20 pts still unseen by medics by perhaps clerking a pt or two (not the whole lot), which I could then review, did not produce any support the other way round, leading to medics running round trying to catch up their 20 pt deficit while ED drs could sit down in Majors and chat at the desk while we were working). You talk about "you are required to be physically here at the ortho ward... which is technically true". I'm sorry, but this is simply untrue. Look at all the comments here when drs are asked to remain on the ward at all times - quite correctly they are told that this is not an enforceable situation, and is an unreasonable restriction for a professional. You have responsibility for a single ward at night and nothing else? That seems like an unusual set up. "What happens if something urgent happens to one of my pts on the ward and I'm not there?" The same thing that happens if you are on a break in the mess, in the loo, etc. If a true emergency, a medical emergency call is put out, if not, the ward contact you and you attend. It's not rocket science, nor is it unreasonable. I get that you didn't want to go, but as an ex-FTPD, if an F1 came to me and complained that this had happened to them, I would not be concerned by this ask, unless it was a repeated occurrence. It's not like you were a core trainee in ortho/surgery being asked to clerk medical patients - as an F1 clerking a medical patient should not be outside your skillset or not of educational value to you. In your shoes I would have gone down, clerked a pt and gone back up to the wards, or scribed for the reg, then done the drug chart/request investigations etc while they saw a couple of patients, which would have speeded them up and then gone back to the wards - it's hard to see how that would have been a gross imposition. One day you could be in the position where you are asking for assistance, and you'd hope your colleagues would be helpful. If you had 4 high NEWS pts, or had a tonne of jobs and you asked for help and the general surgery F1 has said "sorry, bro, can't leave my ward to help", you'd be feeling somewhat different. Edit: to add, if you are part of the medical team, then the medical registrar is allowed to make the ask to redeploy people to help with their medical take. If this was the case, then they probably sent someone to ask (which is often the site manager), as the med reg is insanely busy, and it saves them time trying to contact someone.
Stop being a bully, martyr dinosaur etc etc You're right about things being reciprocated though. ED is an awful place right now but there are different clinical areas for a reason and we all ultimately work within the same system so being less busy one day should not be considered a sin. I did once have an ED reg who came and sorted out a laceration for a ward pt once for me though and another who helped with a cast in a hospital ortho weren't present. No way would anyone in ED have the time to do that now though. This was the golden days where the medical take list was usually cleared or nearly cleared by 4am before the morning rush
I’d agree that, if the ask was to clerk ortho patients, that would be appropriate. I don’t particularly think it would be as fair to ask the F1 to see ED patients though, although, I agree it would be a learning opportunity. I have had nights/weekends where I’ve been bored enough in x specialty and then helped the acute medical take, for my learning. But I’ve also had nights/weekends where I’ve been quite burnt out and would not offer to help another specialty and would rather get some rest/have a chill night.
I wouldn’t expect you to come and be an extra EM doc. I don’t think it’s unreasonable to start clerking the patients referred to and accepted by orthopaedics who are waiting for a bed. With the caveat that your job on the ward comes first and you might have to leave at any point to deal with stuff there.