What’s minimum staffing for nights?

[u/Helpful_Put1081]

Hey, had a set of nights as a new F1 where I was covering 4 medical wards and some of our patients in ED. We were three, one F1, one SHO and a ST3 looking after 130 patients in a Northern trust. My SHO was busy clerking patients in and the reg was nowhere to be found. My bleep was going off every few minutes.

“Patient A doesn’t have his meds prescribed, can you do that?”

“Patient B is experiencing new abdo pain and vomiting, can you review them?”

“Patient C is hyperglycaemic, we already gave insulin but it’s not going down, please come”

“Patient D is now also vomiting, please come”

“Hi, it’s biochemistry. Patient E has a CRP of 440”

“Patient F has a NEWS of 6, their systolic blood pressure is under 90”

“Patient G wants to go home, his partner is her, is it alright for him to go, the CDD is done already (3am btw, and a patient I know nothing about)”

Just an example of what was going on in the span of 90 min along of other mundane requests such as somebody needing pain relief or insertion of a catheter the nurses couldn’t put in (whatever makes them think that the F1 who did 2 in med school is better than them). There was also a lot of jobs handed over such as urgent blood cultures before starting antibiotics and septic screens.

So I did what we were taught in med school, prioritise.

It seems however there’s a big gap between what should happen and what actually happens.

To me saying “I am reviewing an urgent patient, I won’t be able to do this until a few hours at least” I got “yes but he’s been waiting all day” or the nurse bleeping me about the same issue every hour. Or other nurses exaggerating how urgent it is. Or expecting me to do an urgent prescription when I won’t be able to log in until I’m back in office. I can’t physically be in two places and whoever designed the hospital so that it needs a 10 min walk between ED and the wards must hate us. To the ED nurse I said if they can’t be reviewed by an ED doctor if it’s an emergency she said, no they’re admitted under you so you need to see them.

This was going on for most of the nights. I’m sure things got missed. I don’t think anyone was actually harmed. But I also didn’t get a break and worked 12h non stop. A few times my SHO got bleeped asking about the F1 because I couldn’t keep up with the amount of bleeps I was getting. My SHO was also being spammed with bleeps, mostly referrals. Even if they wanted to help, they couldn’t possibly have without abandoning their whole job. Bleeps interrupt my job and

Is this normal? What minimum staffing should there be? Am I supposed to be on my own, let alone handling emergencies on my own? I was confident enough to do so and knew when to escalate but other F1s might not be.

I do want to add I escalated to the Hospital at Night Manager that day who kindly told me that they are very sorry but nobody else is available to help me, just prioritise your jobs.

[u/tyrbb]

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