Life and Death Episode 1: The Chaotic First Shift

Hello and welcome to episode 1 of Life and Death.  That feeling of relief you get when you have worked so hard on placements and assignments, to be given your pin and that realisation that all the hard work you have done has finally paid off.  The sudden moment when you start your first day in the community, on a ward, theatres or an outpatient setting with no more portfolios or clinical competencies to get signed off.

Feels amazing doesn't it...?  Or is it nerve wracking when you arrive on your first day and realise you're on your own with 8 - 12 patients to look after (depending on your place of work).

Fear not, for this episode will showcase what life was like for me when I had my first shift thrown into the deep end and hopefully will provide a bit of reassurance and something you can take away for your own journey.

So, How Did I Feel?

Understandably nervous.  I think anyone who claims they're not nervous about their first shift as newly qualified is either full of shit more than a constipated pensioner is or is more arrogant than Tony Stark and are likely to make a massive mistake.

Fortunately for me, I had a good support network from the staff I was on shift with.  They were willing to help me out if I needed it and I felt like I could ask them anything without being embarrassed.

*Remember no question is a stupid question.  It's better to ask something which seems obvious rather than risk doing something you're not 100% on. Ultimately it's the patients who will suffer.*

I had also spent a lot of my time on placements actively trying to get directly involved in clinical skills and in patient care.  You'll learn by doing more than you'll ever do taking a back seat and watching.

How Did The Shift Go?

Well... chaotic (hence the title).  But overall a really enjoyable experience.  I was assigned 8 patients as the ward could be equally split between all the staff on shift.  Did the morning medication round fine with no dramas.  So far so good.  Made a list of plans following the doctors ward round and any jobs I needed to do

I tend to write things down on paper for each patient - E.g. which patient needed fluid balance charts, any IV medication, plans, anything relevant for the patient.  If I don't write it down, I'll probably forget it.

On patient observations, 2 of mine had a NEWS Score (National Early Warning Score) of 7, with a 3rd patient having a NEWS Score of 8.  Anything over 5 is considered unwell and at risk of deterioration.

Important! Get yourself familiar with the NEWS charts.  This is a vital tool to assist in recognising signs of a poorly patient.  The earlier it's recognised, the sooner treatment can begin.

As per protocol, these patients were escalated to the team of doctors looking after them and also the Critical Care Outreach Team so the patients could be assessed and further treatment plans were put in place.  In addition, these patients would require observations taken every 15 - 30 minutes until their condition improved.  In addition, urgent IV Fluids and IV Antibiotics along with blood samples were required for each patient.  This took up a lot of my time in the morning / early afternoon and I felt a bit behind where I wanted to be - but fortunately all the patients were ok.

As I had not completed my IV Therapy training yet, I had to ask my colleagues to administer any IV fluids or IV Medication.  In return, I mixed up all the afternoon IVs ready for every patient on the ward.  Had a touch of the old Wanker's Claw by the end of it, but it's a team effort.

Thankfully, the afternoon was uneventful, I spent it maintaining the fluid balance charts, changed a couple of dressings and documentation for each patient under my responsibility.  I could then hand over at the end of the day and tick off my first ever shift as qualified.

Important! Accurate and thorough documentation in notes is vital to keep record on what you have done

Things to Take Away

1. Yes, it will seem daunting on your first day.  But with the right support network there, you'll be ok.

2. If in doubt, ask someone.  It's better to ask than do something you're not sure of.

3. Make a plan and write down everything.  Time goes so quick and there's so much going on, it's easy to lose track

4. Learn the NEWS chart.  The earlier you recognise someone going unwell, the faster the treatment can start for that patient.

5. Keep Accurate and Thorough Documentation

6. Enjoy the ride.  It's a team effort, look out for each other on shift.

Thank you for reading, tune in next week for another behind the scenes episode.  If anyone has any requests, feel free to comment or DM me.