My experience of working as a medical registrar on the COVID-19 wards
Please note that this is not about sharing any medical information. This is based on my experience. It may be right, or it may be wrong.
This is a very useful group on Facebook:
https://www.facebook.com/groups/326788934801330/
This is a very useful group on Facebook:
https://www.facebook.com/groups/326788934801330/
I am going to start topic wise:
MY TRUST
We have been very lucky! We are a small seaside town in North Yorkshire and the hospital is a 300 bedded district hospital.
London, Manchester and other big cities were hit first and we have been lagging behind by a time duration of about a week to 2 weeks. Hence, we had time to prepare.
OUR COVID WARDS
We have been using a very modern looking 30 bedded unit which was initially built for surgical patients who needed monitoring but ended up under medicine where we have been managing our influenza patients. It has loads of side rooms, is negative pressure and is located at one end of the hospital building.
This ward is used as a COVID ward. It also has CPAP machines and most of the nurses are trained to use CPAP.
We have a 'step down' ward right under this ward and a few wards nearby ( all located at one end of the hospital). These are how we have distributed them:
1. All patients who are COVID positive are transferred to that step down ward.
2. All patients who are COVID 19 negative ( on their swabs) but their CXR/CT scans/clinical picture is highly suggestive of COVID-19 are transferred to another ward which has side rooms.
STAFFING
The COVID wards have a dedicated team of doctors:
1 medical registrar doing 12 hour shifts - day and night
7 junior doctors during the day
3 junior doctors during the night which can be extended to 5 ( there is a medical registrar and 2 junior doctors on the non COVID side who can be used when required).
Consultants - 2 for the main admitting/CPAP ward, 1 for the step down ward and 1 for the other ( COVID negative but highly suggestive investigations/clinical picture). These consultants cover these wards from 0900 to 1700 and some even stay till 2000 where necessary. There is also 0900 to 2000 consultant cover on these COVID wards on the weekends.
We communicate with each other via WhatsApp ( we do not disclose any patients details or any confidential data) to ensure no one is overworked and if anyone needs a hand.
HOW WE ADMIT PATIENTS
The ED is now divided into a COVID ( also known as Respiratory assessment zone - RAZ) and non covid part. Initially RAZ had 4 beds, it now has 12 beds. It has facilities to intubate where necessary and monitoring.
The ? COVID patients are transferred from RAZ to the COVID ward.
Any patient who has a high EWS or is requiring a lot of oxygen is discussed with the COVID medical registrar ( we carry a bleep) - we have a look at the numbers, clinical picture on the computer and then make a decision of what to do.
If they are for full escalation, I ask for an ITU opinion
If I feel that they are not suitable for CPR/intubation, I request the ED team to put a DNACPR in the patients notes after discussing this with the patient/relatives ( if the patient lacks capacity and the next of kin is not available, we put one in the patients best interests). The reason behind this is that:
ALL PATIENTS LEAVING ED SHOULD HAVE AN ESCALATION PLAN.
My worry is that they can CRASH en route and hence we should make a joint decision.
Hence, we have a very clear care plan which the ED team fills out ( especially the escalation part):
HOW I CLERK PATIENTS
I have a 2 minute rule.
STABLE PATIENTS
I have already been given the full history from the ED team when I have taken a handover.
I also read the ambulance service's electronic documentation which is scanned and put on the computer system ( this has vital information about baseline function, etc).
I have already seen the CXR, ECG, bloods, treatment the patient has received in ED, ABG ( if the patient is requiring O2).
I have already decided the escalation plan and there is a DNACPR in the patients notes from ED ( which I always check).
I have checked the medication history as the ED clerk uploads the latest summary care record from the GP which includes medications ( and sometimes, even the past medical history of the patient)
When the patient enters the COVID ward, I quickly ask any questions which were missed by the ambulance service/ED team ( it is usually just the dose of insulin. The ED team in my trust is very thorough as we have a clear rule- clerk once, and clerk right - be it the ED team or specialty teams), quickly examine the chest while the patient is being transferred from the ED trolley to the ward bed, listen to the heart sounds, check for pedal oedema and mention the plan - which involves antibiotics, cautious fluids.
UNWELL PATIENTS
The same points as above
PLUS
I again mention to the patient what we will do and what the medical team jointly feels will prolong agony or distress if the patient.
IF THEY ARE FOR CPAP
These patients have already been discussed with ITU on the phone by the ED team who sometimes suggest to transfer them to the COVID ward for CPAP and if they deteriorate, they are for ITU / ward based care. This is clearly documented in the care plan and I have already received a verbal handover of these patients.
I inform the nurse in charge who then gets the CPAP machine, switches it on, sets it up and as soon as the patient comes into the room, I quickly mention the plan, leave the room and the nurses don in PPE and start them on CPAP. We start patients on CPAP within a few minutes of entering the ward.
I ensure the CPAP machine is towards the window in the hallway and the obs machine, catheter is visible. This avoids people like nurses, HCAs going into the room unnecessarily. If they are deteriorating, I quickly inform the ITU team and they transfer the patient to ITU for intubation ASAP if they are for full escalation.
HOW I ASSESS UNWELL PATIENTS
I have a one minute rule for doing bloods, ABGs, cannulas. As a medical registrar, I ensure the SHOs and FY1s are aware of this as well. If they are struggling with this, they are to leave the room immediately and bleep me.
If I struggle, I bleep the most experienced SHO/FY1 I know who will manage it.
I quickly make a decision on escalation plans and then inform the patient/next of kin. If I am confused, I call the consultant ASAP. If the consultant is unavailable, I bleep ITU.
TIPS:
1. All patients should have a clear escalation plan. If you struggle, talk to the medical registrar. If the medical registrar struggles, (s)he is to talk to the consultant on call/ITU team.
2. Avoid unnecessary exposure. Doctors become unwell when they have been trying to do bloods for up to 20 minutes, have been staying in the room for long.
Unfortunately, in a pandemic you need to protect yourself and your colleagues. Hence, make quick decisions and escalate where necessary.
3. Be helpful and kind. If you are going in a room too assess a patient, ask the nurses/HCAs if they need anything. While going in to talk to the patient, you can do OBS, check the urine output and even pass food/snacks to the patient avoiding unnecessary exposure of nurses and HCAs.
4. Communicate! Inform the nurse in charge about your plan INCLUDING escalation plans. Call the family and update them. They are not allowed to come to visit their loved ones and it is very scary for them. In some trusts, including mine they have introduced iPads with zoom installed on them which patients can use to communicate with their relatives. Despite that, we MUST inform the next of kin ( after the patients consent) and update them about the management plans clearly.
5. Think outside the box. The care plan was made by a trainee FY2 and an ACCS trainee. They got it approved by the ED consultants and directorate within a few days.
NON COVID PATIENTS
I have seen so many patients with atypical features coming back to be COVID-19 positive a few days later. I am being extra cautious even when it comes to non COVID patients.
Here are some interesting cases I saw:
Elderly gentleman, long admission. I was asked to see him because he had a mild tickly cough.
Elderly patient, loose stools and lymphopenia
All of these patients had positive COVID-19 swabs.
As a registrar, I am frequently asked to review patients by nurses who have 'new symptoms'. I never take a chance and manage them as if they are COVID-19 patients and follow my local protocols ( which currently are to transfer the patient ASAP to the COVID19 wards after discussing this with the consultant on the COVID wards)
PPE
This is a nightmare for every trust and every health care professional. Health care professionals are becoming unwell, a few have passed away with COVID-19 and hence this should be taken very seriously.
In my trust, as the main admitting ward has CPAP which is aerosol generating and the nurses station, doctors room are close by, we have to wear full PPE when we are working on that ward.
I also wear scrubs, face protection and surgical mask when on the non COVID side- the reason being that all CRASH calls are now managed as a potential/confirmed COVID CRASH. And the medical registrar on call is a member of the CRASH team hence I need to be in scrubs to avoid wasting time.
TIPS:
1. You must follow the PHE and WHO guidelines when it comes to PPE.
The guideline changes frequently hence follow the guidance here:
https://www.england.nhs.uk/coronavirus/secondary-care/prevention/personal-protective-equipment-ppe/
2. If you do not understand why something which is official, then please raise it. There are different ways of raising concerns:
- On social media: Not a good idea. It is ineffective and you can get into trouble.
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/doctors-use-of-social-media
- Talking with colleagues: Are they going to do something about it? If not, then do not bother.
- Management: They listen! They help. I have personally experienced this. The best way is to talk to your colleagues, registrars and consultants. Reach a consensus and one of you should email the management ( in my trust there is a dedicated manager who takes all suggestions and then feeds it back efficiently and immediately to whoever is relevant.).
MY TRUST
We have been very lucky! We are a small seaside town in North Yorkshire and the hospital is a 300 bedded district hospital.
London, Manchester and other big cities were hit first and we have been lagging behind by a time duration of about a week to 2 weeks. Hence, we had time to prepare.
OUR COVID WARDS
We have been using a very modern looking 30 bedded unit which was initially built for surgical patients who needed monitoring but ended up under medicine where we have been managing our influenza patients. It has loads of side rooms, is negative pressure and is located at one end of the hospital building.
This ward is used as a COVID ward. It also has CPAP machines and most of the nurses are trained to use CPAP.
We have a 'step down' ward right under this ward and a few wards nearby ( all located at one end of the hospital). These are how we have distributed them:
1. All patients who are COVID positive are transferred to that step down ward.
2. All patients who are COVID 19 negative ( on their swabs) but their CXR/CT scans/clinical picture is highly suggestive of COVID-19 are transferred to another ward which has side rooms.
STAFFING
The COVID wards have a dedicated team of doctors:
1 medical registrar doing 12 hour shifts - day and night
7 junior doctors during the day
3 junior doctors during the night which can be extended to 5 ( there is a medical registrar and 2 junior doctors on the non COVID side who can be used when required).
Consultants - 2 for the main admitting/CPAP ward, 1 for the step down ward and 1 for the other ( COVID negative but highly suggestive investigations/clinical picture). These consultants cover these wards from 0900 to 1700 and some even stay till 2000 where necessary. There is also 0900 to 2000 consultant cover on these COVID wards on the weekends.
We communicate with each other via WhatsApp ( we do not disclose any patients details or any confidential data) to ensure no one is overworked and if anyone needs a hand.
HOW WE ADMIT PATIENTS
The ED is now divided into a COVID ( also known as Respiratory assessment zone - RAZ) and non covid part. Initially RAZ had 4 beds, it now has 12 beds. It has facilities to intubate where necessary and monitoring.
The ? COVID patients are transferred from RAZ to the COVID ward.
Any patient who has a high EWS or is requiring a lot of oxygen is discussed with the COVID medical registrar ( we carry a bleep) - we have a look at the numbers, clinical picture on the computer and then make a decision of what to do.
If they are for full escalation, I ask for an ITU opinion
If I feel that they are not suitable for CPR/intubation, I request the ED team to put a DNACPR in the patients notes after discussing this with the patient/relatives ( if the patient lacks capacity and the next of kin is not available, we put one in the patients best interests). The reason behind this is that:
ALL PATIENTS LEAVING ED SHOULD HAVE AN ESCALATION PLAN.
My worry is that they can CRASH en route and hence we should make a joint decision.
Hence, we have a very clear care plan which the ED team fills out ( especially the escalation part):
HOW I CLERK PATIENTS
I have a 2 minute rule.
STABLE PATIENTS
I have already been given the full history from the ED team when I have taken a handover.
I also read the ambulance service's electronic documentation which is scanned and put on the computer system ( this has vital information about baseline function, etc).
I have already seen the CXR, ECG, bloods, treatment the patient has received in ED, ABG ( if the patient is requiring O2).
I have already decided the escalation plan and there is a DNACPR in the patients notes from ED ( which I always check).
I have checked the medication history as the ED clerk uploads the latest summary care record from the GP which includes medications ( and sometimes, even the past medical history of the patient)
When the patient enters the COVID ward, I quickly ask any questions which were missed by the ambulance service/ED team ( it is usually just the dose of insulin. The ED team in my trust is very thorough as we have a clear rule- clerk once, and clerk right - be it the ED team or specialty teams), quickly examine the chest while the patient is being transferred from the ED trolley to the ward bed, listen to the heart sounds, check for pedal oedema and mention the plan - which involves antibiotics, cautious fluids.
UNWELL PATIENTS
The same points as above
PLUS
I again mention to the patient what we will do and what the medical team jointly feels will prolong agony or distress if the patient.
IF THEY ARE FOR CPAP
These patients have already been discussed with ITU on the phone by the ED team who sometimes suggest to transfer them to the COVID ward for CPAP and if they deteriorate, they are for ITU / ward based care. This is clearly documented in the care plan and I have already received a verbal handover of these patients.
I inform the nurse in charge who then gets the CPAP machine, switches it on, sets it up and as soon as the patient comes into the room, I quickly mention the plan, leave the room and the nurses don in PPE and start them on CPAP. We start patients on CPAP within a few minutes of entering the ward.
I ensure the CPAP machine is towards the window in the hallway and the obs machine, catheter is visible. This avoids people like nurses, HCAs going into the room unnecessarily. If they are deteriorating, I quickly inform the ITU team and they transfer the patient to ITU for intubation ASAP if they are for full escalation.
HOW I ASSESS UNWELL PATIENTS
I have a one minute rule for doing bloods, ABGs, cannulas. As a medical registrar, I ensure the SHOs and FY1s are aware of this as well. If they are struggling with this, they are to leave the room immediately and bleep me.
If I struggle, I bleep the most experienced SHO/FY1 I know who will manage it.
I quickly make a decision on escalation plans and then inform the patient/next of kin. If I am confused, I call the consultant ASAP. If the consultant is unavailable, I bleep ITU.
TIPS:
1. All patients should have a clear escalation plan. If you struggle, talk to the medical registrar. If the medical registrar struggles, (s)he is to talk to the consultant on call/ITU team.
2. Avoid unnecessary exposure. Doctors become unwell when they have been trying to do bloods for up to 20 minutes, have been staying in the room for long.
Unfortunately, in a pandemic you need to protect yourself and your colleagues. Hence, make quick decisions and escalate where necessary.
3. Be helpful and kind. If you are going in a room too assess a patient, ask the nurses/HCAs if they need anything. While going in to talk to the patient, you can do OBS, check the urine output and even pass food/snacks to the patient avoiding unnecessary exposure of nurses and HCAs.
4. Communicate! Inform the nurse in charge about your plan INCLUDING escalation plans. Call the family and update them. They are not allowed to come to visit their loved ones and it is very scary for them. In some trusts, including mine they have introduced iPads with zoom installed on them which patients can use to communicate with their relatives. Despite that, we MUST inform the next of kin ( after the patients consent) and update them about the management plans clearly.
5. Think outside the box. The care plan was made by a trainee FY2 and an ACCS trainee. They got it approved by the ED consultants and directorate within a few days.
NON COVID PATIENTS
I have seen so many patients with atypical features coming back to be COVID-19 positive a few days later. I am being extra cautious even when it comes to non COVID patients.
Here are some interesting cases I saw:
Elderly gentleman, long admission. I was asked to see him because he had a mild tickly cough.
Elderly patient, loose stools and lymphopenia
All of these patients had positive COVID-19 swabs.
As a registrar, I am frequently asked to review patients by nurses who have 'new symptoms'. I never take a chance and manage them as if they are COVID-19 patients and follow my local protocols ( which currently are to transfer the patient ASAP to the COVID19 wards after discussing this with the consultant on the COVID wards)
PPE
This is a nightmare for every trust and every health care professional. Health care professionals are becoming unwell, a few have passed away with COVID-19 and hence this should be taken very seriously.
In my trust, as the main admitting ward has CPAP which is aerosol generating and the nurses station, doctors room are close by, we have to wear full PPE when we are working on that ward.
I also wear scrubs, face protection and surgical mask when on the non COVID side- the reason being that all CRASH calls are now managed as a potential/confirmed COVID CRASH. And the medical registrar on call is a member of the CRASH team hence I need to be in scrubs to avoid wasting time.
TIPS:
1. You must follow the PHE and WHO guidelines when it comes to PPE.
The guideline changes frequently hence follow the guidance here:
https://www.england.nhs.uk/coronavirus/secondary-care/prevention/personal-protective-equipment-ppe/
2. If you do not understand why something which is official, then please raise it. There are different ways of raising concerns:
- On social media: Not a good idea. It is ineffective and you can get into trouble.
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/doctors-use-of-social-media
- Talking with colleagues: Are they going to do something about it? If not, then do not bother.
- Management: They listen! They help. I have personally experienced this. The best way is to talk to your colleagues, registrars and consultants. Reach a consensus and one of you should email the management ( in my trust there is a dedicated manager who takes all suggestions and then feeds it back efficiently and immediately to whoever is relevant.).
MANAGEMENT
As mentioned above, they are extremely helpful. I go way back when it comes to this.
Before this pandemic, we had a paired learning program in which doctors and managers would get to know each other and shadow each other. Luckily, I was paired up with a very senior and hard working manager. She observed me on my on calls and gave me suggestions and even fed back my opinions to the higher ups. I attended a few meetings and learnt about the concerns they have.
As I am an acute medical registrar, I am passionate about patient flow - this is what acute medicine is all about- ensuring quick and safe discharges/transfers to other specialties. I get along with discharge officers, bed managers for this very reason. I also did loads of shifts on ambulatory care and discharge registrar shifts. I understood their plight and they understood mine.
Hence, when this pandemic started in the big cities and we had not been hit yet, the management asked me and a few others to do the following:
1. Make a rota for registrars/SHOs and FY1s
2. Take suggestions from everyone and feed it back to the management
Together, we worked on a lot of things and here are a few highlights:
1. We made a new rota for medical doctors and have included doctors from other specialties which are not too busy
2. We have made WhatsApp groups ( COVID wards, non COVID wards, non COVID on calls) which not only have all doctors but also members of the management as well where we share our concerns and then one of us emails the management.
3. Ensured that all health care professionals are looked after - in every way possible.
As mentioned above, they are extremely helpful. I go way back when it comes to this.
Before this pandemic, we had a paired learning program in which doctors and managers would get to know each other and shadow each other. Luckily, I was paired up with a very senior and hard working manager. She observed me on my on calls and gave me suggestions and even fed back my opinions to the higher ups. I attended a few meetings and learnt about the concerns they have.
As I am an acute medical registrar, I am passionate about patient flow - this is what acute medicine is all about- ensuring quick and safe discharges/transfers to other specialties. I get along with discharge officers, bed managers for this very reason. I also did loads of shifts on ambulatory care and discharge registrar shifts. I understood their plight and they understood mine.
Hence, when this pandemic started in the big cities and we had not been hit yet, the management asked me and a few others to do the following:
1. Make a rota for registrars/SHOs and FY1s
2. Take suggestions from everyone and feed it back to the management
Together, we worked on a lot of things and here are a few highlights:
1. We made a new rota for medical doctors and have included doctors from other specialties which are not too busy
2. We have made WhatsApp groups ( COVID wards, non COVID wards, non COVID on calls) which not only have all doctors but also members of the management as well where we share our concerns and then one of us emails the management.
3. Ensured that all health care professionals are looked after - in every way possible.
ROTA
We have 11 registrars, 11 FY1s in medicine and 31 SHOs.
When we were approached to make a rota, we had no idea where to start. However our sister trust ( which is double in size) and had been hit earlier already made a rota ( but with more registrars).
We decided on the following:
1. All registrars will either be on call on COVID, non COVID calls, on 0900 to 1700 ward registrar shifts, on zero days or on reserve.
2. To honor any leaves which were preplanned and were important.
This is what we came up with:
The dates highlighted orange are non COVID long days from 0830 to 2100
The dates highlighted yellow are COVID long days from 0830 to 2100
The dates highlighted green are non COVID nights from 2100 to 0830
The dates highlighted pink are COVID nights from 2100 to 0830
The underlined days are weekends/Zero days
The non underlined days are normal working days from 0900 to 1700
The dates in a red box are reserve shifts.
The circled days are my annual leaves.
The advantage of this rota is:
1. Maximum 2 days exposure to COVID patients in a week.
2. Maximum 4 day shifts
3. On the reserve shift, we are paid from 0900 to 1700 even though we are at home and the management plans to pay us for any extra hours we need to work if we are asked to come in.
4. There are 2 registrars on reserve at any one time.
5. The reserve days are like annual leaves unless we have been asked to come in.
6. The coordinating registrar ( Hospital day) comes in at 0830, checks the list of patients and then allocates junior doctors to the wards. Plus, (s)he helps in ambulatory care when required, on the wards where needed and this way, helps with patient flow on the non COVID side.
Similarly, a SHO and FY1 rota has been designed- there are 7 to 8 junior doctors on the non COVID wards ( which are now only 5 with a consultant ward round almost daily) and they are allocated to different wards ( with the view of maintaining continuity of specialties wherever possible. ie a IMT trainee who was working on the gastro ward will be allocated to the same ward, etc).
If anyone needs any assistance, they ask on the WhatsApp group and people very kindly come to help.
Like the registrar rota, the SHO/FY1 rota also has reserves.
PAY
As you might be aware, there have been changes in the rota in most trusts. The frequency of calls has changed and the number of weekends has increased.
You should be receiving a higher pay now.
I am a trainee registrar and my on call shift pattern has increased from 1 in 5 weekends to 1 in 2 weekends. My night shift pattern has increased as well.
My pay is based on these factors:
Basic Pay - same
Addn Roster Hours - same
NP Night Duty 37% - increased
Weekend 1 in 2 - increased from 1 in 5
FAQs about pay:
How can I check my payslip?
https://my.esr.nhs.uk/
If you do not have access to this, you can search for 'ESR' in you work email and find a link to your ESR
Can I get access to ESR remotely?
Yes, you can access your ESR account remotely however you may need to access it first from your work email first.
My trust does not have ESR
Talk to your HR/payroll department and find out how to get access to your payslips.
How do I know I am paid correctly?
https://www.nhsemployers.org/pay-pensions-and-reward/medical-staff/pay-circulars
Some trusts are following the previous years' pay schedule.
How can I find out which pay circular applies to me?
By checking your work schedule and contract.
I am a non trainee
It does not matter. You should be at a post equivalent to some training grade ( FY2 vs CT1 vs ST3 etc ) as mentioned in your contract and work schedule.
My trust says I am not eligible for a pay rise/change in working hours even though I am doing more as I am a non trainee.
Contact your HR, payroll team. If they refuse to acknowledge that you are doing the same work at the same level as your trainee counterparts, then you will have to escalate it to the BMA.
I am still struggling to get a pay rise despite all of this whereas my trainee counterparts have received a considerable pay rise for the same on calls.
In my opinion, you need to take this higher then. https://omarsguidelines.blogspot.com/2020/01/bullying-and-stress-in-nhs.html
THE OATH YOU HAVE TAKEN AS A DOCTOR
Patients come first! This is what we have been taught and have practiced. However, in a pandemic this changes. We need to protect ourselves as much as our patients. You can see how the resus UK guidelines have changed when it comes to managing CRASH calls -
This is just an example:
https://www.youtube.com/watch?v=NXLrIWSf2Y0
( Please note that this may change and hence follow your trust policy as well)
So in summary, do not try to be a superhero! Do not do anything that will risk your life.
Personally, as a medical registrar the hardest thing for me is to connect the defib pads, shock/not shock and leave the room to don fully before coming in to the room to start CPR/ lead the CRASH.
We have 11 registrars, 11 FY1s in medicine and 31 SHOs.
When we were approached to make a rota, we had no idea where to start. However our sister trust ( which is double in size) and had been hit earlier already made a rota ( but with more registrars).
We decided on the following:
1. All registrars will either be on call on COVID, non COVID calls, on 0900 to 1700 ward registrar shifts, on zero days or on reserve.
2. To honor any leaves which were preplanned and were important.
This is what we came up with:
This is my rota till the 31st of May:
The dates highlighted yellow are COVID long days from 0830 to 2100
The dates highlighted green are non COVID nights from 2100 to 0830
The dates highlighted pink are COVID nights from 2100 to 0830
The underlined days are weekends/Zero days
The non underlined days are normal working days from 0900 to 1700
The dates in a red box are reserve shifts.
The circled days are my annual leaves.
The advantage of this rota is:
1. Maximum 2 days exposure to COVID patients in a week.
2. Maximum 4 day shifts
3. On the reserve shift, we are paid from 0900 to 1700 even though we are at home and the management plans to pay us for any extra hours we need to work if we are asked to come in.
4. There are 2 registrars on reserve at any one time.
5. The reserve days are like annual leaves unless we have been asked to come in.
6. The coordinating registrar ( Hospital day) comes in at 0830, checks the list of patients and then allocates junior doctors to the wards. Plus, (s)he helps in ambulatory care when required, on the wards where needed and this way, helps with patient flow on the non COVID side.
Similarly, a SHO and FY1 rota has been designed- there are 7 to 8 junior doctors on the non COVID wards ( which are now only 5 with a consultant ward round almost daily) and they are allocated to different wards ( with the view of maintaining continuity of specialties wherever possible. ie a IMT trainee who was working on the gastro ward will be allocated to the same ward, etc).
If anyone needs any assistance, they ask on the WhatsApp group and people very kindly come to help.
Like the registrar rota, the SHO/FY1 rota also has reserves.
PAY
As you might be aware, there have been changes in the rota in most trusts. The frequency of calls has changed and the number of weekends has increased.
You should be receiving a higher pay now.
I am a trainee registrar and my on call shift pattern has increased from 1 in 5 weekends to 1 in 2 weekends. My night shift pattern has increased as well.
My pay is based on these factors:
Basic Pay - same
Addn Roster Hours - same
NP Night Duty 37% - increased
Weekend 1 in 2 - increased from 1 in 5
FAQs about pay:
How can I check my payslip?
https://my.esr.nhs.uk/
If you do not have access to this, you can search for 'ESR' in you work email and find a link to your ESR
Can I get access to ESR remotely?
Yes, you can access your ESR account remotely however you may need to access it first from your work email first.
My trust does not have ESR
Talk to your HR/payroll department and find out how to get access to your payslips.
How do I know I am paid correctly?
https://www.nhsemployers.org/pay-pensions-and-reward/medical-staff/pay-circulars
Some trusts are following the previous years' pay schedule.
How can I find out which pay circular applies to me?
By checking your work schedule and contract.
I am a non trainee
It does not matter. You should be at a post equivalent to some training grade ( FY2 vs CT1 vs ST3 etc ) as mentioned in your contract and work schedule.
My trust says I am not eligible for a pay rise/change in working hours even though I am doing more as I am a non trainee.
Contact your HR, payroll team. If they refuse to acknowledge that you are doing the same work at the same level as your trainee counterparts, then you will have to escalate it to the BMA.
I am still struggling to get a pay rise despite all of this whereas my trainee counterparts have received a considerable pay rise for the same on calls.
In my opinion, you need to take this higher then. https://omarsguidelines.blogspot.com/2020/01/bullying-and-stress-in-nhs.html
THE OATH YOU HAVE TAKEN AS A DOCTOR
Patients come first! This is what we have been taught and have practiced. However, in a pandemic this changes. We need to protect ourselves as much as our patients. You can see how the resus UK guidelines have changed when it comes to managing CRASH calls -
This is just an example:
https://www.youtube.com/watch?v=NXLrIWSf2Y0
( Please note that this may change and hence follow your trust policy as well)
So in summary, do not try to be a superhero! Do not do anything that will risk your life.
Personally, as a medical registrar the hardest thing for me is to connect the defib pads, shock/not shock and leave the room to don fully before coming in to the room to start CPR/ lead the CRASH.
NEW TREATMENTS AND RESEARCH
Hospitals are constantly doing trials and research. However follow your trusts guidelines. Please do not follow a random Facebook post or a WhatsApp message about some novel treatment. Remember the GMC guidance.
If you are interested, talk to the COVID-19 lead of your trust and you can get involved in research. Just remember to avoid exposure to patients wherever possible.
Hospitals are constantly doing trials and research. However follow your trusts guidelines. Please do not follow a random Facebook post or a WhatsApp message about some novel treatment. Remember the GMC guidance.
If you are interested, talk to the COVID-19 lead of your trust and you can get involved in research. Just remember to avoid exposure to patients wherever possible.
SOCIALIZING AT WORK
When I was on call, prior to the pandemic I used to base myself in ED as the medical registrar on call. This helped me clerk patients faster and I was able to request the necessary urgent investigations there and transfer patients to appropriate specialties. I got to know my ED colleagues very well and we became good friends. I could never spend a minute alone and even if there was no patient to clerk, I used to station myself in ED when there was nothing exciting on the wards.
When I was on CCU ( as part of my 6 monthly placement as an acute internal medical registrar), I used to go to the respiratory ward ( which was the first ward I started as a ST3 trainee) and meet my colleagues there.
However, with this pandemic things have changed. There are undiagnosed COVID 19 patients on the non COVID wards as well ( became symptomatic later, relatives who were possibly infected/carriers infected them, etc). ED has now essentially been converted into a huge COVID 19 assessment zone as well.
This has made my socializing very limited. I do not want to visit wards unnecessarily and only go there if patients are unwell ( and I still adhere to my 2 minute rule even then ).
This has become very depressing and it is hard to not to do this. I am glad that I am on call on the non COVID side just 2 days/nights every 2 weeks.
When I was on call, prior to the pandemic I used to base myself in ED as the medical registrar on call. This helped me clerk patients faster and I was able to request the necessary urgent investigations there and transfer patients to appropriate specialties. I got to know my ED colleagues very well and we became good friends. I could never spend a minute alone and even if there was no patient to clerk, I used to station myself in ED when there was nothing exciting on the wards.
When I was on CCU ( as part of my 6 monthly placement as an acute internal medical registrar), I used to go to the respiratory ward ( which was the first ward I started as a ST3 trainee) and meet my colleagues there.
However, with this pandemic things have changed. There are undiagnosed COVID 19 patients on the non COVID wards as well ( became symptomatic later, relatives who were possibly infected/carriers infected them, etc). ED has now essentially been converted into a huge COVID 19 assessment zone as well.
This has made my socializing very limited. I do not want to visit wards unnecessarily and only go there if patients are unwell ( and I still adhere to my 2 minute rule even then ).
This has become very depressing and it is hard to not to do this. I am glad that I am on call on the non COVID side just 2 days/nights every 2 weeks.
LEADERSHIP:
This is an excellent time to show leadership skills - be it talking to your colleagues, making care plans, arranging a way for patients to communicate with their families, communicating with management, etc.
It does not matter whether you are a doctor on a visa, locum doctor, FY1, FY2 - we are all equally important. So please share your suggestions.
In my trust, a FY2 trainee and ACCS trainee arranged iPads for patients to communicate with relatives and they also made a care plan. No registrar/consultant thought about it.
This is an excellent time to show leadership skills - be it talking to your colleagues, making care plans, arranging a way for patients to communicate with their families, communicating with management, etc.
It does not matter whether you are a doctor on a visa, locum doctor, FY1, FY2 - we are all equally important. So please share your suggestions.
In my trust, a FY2 trainee and ACCS trainee arranged iPads for patients to communicate with relatives and they also made a care plan. No registrar/consultant thought about it.
CONSULTANTS:
The consultants in my trust are working extra hard! The ones on the COVID wards sometimes stay till late to ensure all unwell patients have clear plans and some even work for 5 days a week, then take a week off to come back again.
They find it very overwhelming initially and it is our job to ensure they are well supported. Try to talk to them. And suggest that they should talk to you as well. Venting out is healthy. This is a terrible virus!
I have noticed that the consultants who have noted worked on the COVID wards have no idea what it is like. Some think that juniors are just sitting there whereas they should be following their parent teams consultants on ward rounds.
This does make my blood boil and I have instances in which I had an argument with a few consultants but I have learnt to control my temper and also understand that they do not know what it is like on the COVID wards until they have worked there.
TIPS:
Do not get upset if a consultant says something unreasonable. Try your best to explain things to him/her but do not argue.
Escalate if you are concerned.
The consultants in my trust are working extra hard! The ones on the COVID wards sometimes stay till late to ensure all unwell patients have clear plans and some even work for 5 days a week, then take a week off to come back again.
They find it very overwhelming initially and it is our job to ensure they are well supported. Try to talk to them. And suggest that they should talk to you as well. Venting out is healthy. This is a terrible virus!
I have noticed that the consultants who have noted worked on the COVID wards have no idea what it is like. Some think that juniors are just sitting there whereas they should be following their parent teams consultants on ward rounds.
This does make my blood boil and I have instances in which I had an argument with a few consultants but I have learnt to control my temper and also understand that they do not know what it is like on the COVID wards until they have worked there.
TIPS:
Do not get upset if a consultant says something unreasonable. Try your best to explain things to him/her but do not argue.
Escalate if you are concerned.
NURSES AND HCAs
Nurses are on long shifts and some have had a maximum of 2 days off to come back to the same COVID wards! This is unacceptable. They should have a rota like doctors. They should avoid prolonged viral exposure.
Keep teaching them about this disease. Show them chest X rays- also show them interesting cases ( my favorite one is a middle aged guy with some co morbidities who is now improving in ITU- I show them the patients CXR before and after a few days of intubation).
Also ensure they adhere to the PPE guidelines. Ensure they rest well and also help them on the ward round- like doing their OBS, urine output checking and even giving food to the patient when you have gone in to do your 2 minute assessment. Small things like ensuring the CPAP machine, OBS machine and catheter bag are facing the window can avoid exposure of nurses and HCAs.
If you think that they are being over-exposed, contact the matron in charge and chief nurse.
I personally feel that all healthcare professionals should have a rota similar to us registrars - 2 days/nights on the non COVID wards, then 2 days/nights on the COVID wards, off for a few days, then on reserve, on non COVID normal days to repeat this cycle.
Nurses are on long shifts and some have had a maximum of 2 days off to come back to the same COVID wards! This is unacceptable. They should have a rota like doctors. They should avoid prolonged viral exposure.
Keep teaching them about this disease. Show them chest X rays- also show them interesting cases ( my favorite one is a middle aged guy with some co morbidities who is now improving in ITU- I show them the patients CXR before and after a few days of intubation).
Also ensure they adhere to the PPE guidelines. Ensure they rest well and also help them on the ward round- like doing their OBS, urine output checking and even giving food to the patient when you have gone in to do your 2 minute assessment. Small things like ensuring the CPAP machine, OBS machine and catheter bag are facing the window can avoid exposure of nurses and HCAs.
If you think that they are being over-exposed, contact the matron in charge and chief nurse.
I personally feel that all healthcare professionals should have a rota similar to us registrars - 2 days/nights on the non COVID wards, then 2 days/nights on the COVID wards, off for a few days, then on reserve, on non COVID normal days to repeat this cycle.
OTHER HEALTH CARE PROFESSIONALS
Also do not forget your ward clerks, physotherapists, discharge coordinators. Avoid exposure as much as possible - ie, does this dying COVID-19 patient who is 100 years old with a frailty score of 8 who is not responding to active treatment actually need suctioning or is hyoscine subcutaneously more appropriate?
Also do not forget your ward clerks, physotherapists, discharge coordinators. Avoid exposure as much as possible - ie, does this dying COVID-19 patient who is 100 years old with a frailty score of 8 who is not responding to active treatment actually need suctioning or is hyoscine subcutaneously more appropriate?
CONCERNS ABOUT HEALTHCARE PROFESSIONALS ON VISAS
This is something my British colleagues may not be familiar with.
Healthcare professionals on visas who have dependents here in the UK ( on dependent visas- ie spouse, children) will be asked to leave the country IF the doctor passes away.
Hence, there are quite a few (actually a lot) of petitions going around to grant citizenship too NHS workers automatically ( the current rule is that you have to work in the UK on a work visa for at least 5 years).
Here are my concerns:
1. There are so many petitions going on that it is all very 'diluted' now. None of these dozens of petitions have crossed 20,000 votes.
2. Some people say that this is an opportunistic approach - those people clearly do not have dependents!
Here is my suggestion:
1. Cancel ALL petitions
2. Make one petition after liaising with major organizations like BMA, BAPIO, DAUK, Everydoctor, etc. with the following request
- The dependents of ALL healthcare workers in the NHS who pass away get automatic citizenship.
- This includes nurses, HCAs, physios, OTs, ward clerks - basically ALL NHS healthcare workers who are here on visas and have dependents in the UK.
This is something my British colleagues may not be familiar with.
Healthcare professionals on visas who have dependents here in the UK ( on dependent visas- ie spouse, children) will be asked to leave the country IF the doctor passes away.
Hence, there are quite a few (actually a lot) of petitions going around to grant citizenship too NHS workers automatically ( the current rule is that you have to work in the UK on a work visa for at least 5 years).
Here are my concerns:
1. There are so many petitions going on that it is all very 'diluted' now. None of these dozens of petitions have crossed 20,000 votes.
2. Some people say that this is an opportunistic approach - those people clearly do not have dependents!
Here is my suggestion:
1. Cancel ALL petitions
2. Make one petition after liaising with major organizations like BMA, BAPIO, DAUK, Everydoctor, etc. with the following request
- The dependents of ALL healthcare workers in the NHS who pass away get automatic citizenship.
- This includes nurses, HCAs, physios, OTs, ward clerks - basically ALL NHS healthcare workers who are here on visas and have dependents in the UK.
ARE WE GOING TO DIE??????
You have seen the news, you have seen the statistics. You cannot change this. However what you can change is your approach. And by this I mean:
PLANNING:
1. Make a will.
https://www.gov.uk/make-will
This is important especially if you have dependents.
2. Ensure your NHS pensions is updated with a nominee ( if it is not your spouse)
You can find this information here:
https://www.nhsbsa.nhs.uk/nhs-pensions
BRING CHANGES WHICH WILL MAKE US SAFE
We know that PPE helps. We know what the official guidance by PHE and WHO are. Follow them! Also talk to your management if you are worried.
REMEMBER THE PEOPLE WHO WALKED OUT OF HOSPITAL
In my case, a 85 year old plus patient walked out of hospital in a week despite being unwell.
TAKE CARE OF YOURSELF
If you become symptomatic, self isolate. You are not only putting yourself at risk but patients and colleagues at risk.
The rota will go on, they will find people. Do not worry.
BE KIND
This is the time to learn empathy, kindness and love. Be it your colleague or a family member. Or a random elderly neighbour whom you help with shopping, never ever stop being kind. This is the only thing which will get us through this pandemic.
GIVE YOURSELF A BREAK
Have I broken down? Yes
Have I got up? Yes
This was only possible by taking a break - luckily I was off for 3 days after having an argument with someone and the break helped me vent and also reflect upon this situation.
APPRECIATE EVERYONE
It is not only NHS workers who are working hard, it is their spouses, their children, it is the avid mountain climber who is social distancing at home, it is the smoker who has quit because he wanted to avoid spreading it to others by smoking on the pavement, it is the bus drivers, the taxi drivers, the cleaners, the garbage men, the people who have now become unemployed because they had to close their pubs/restaurants. Every single member of society has played an important role!
OUR MENTAL WELL BEING
We will break, some of us will suffer from PTSD. Find the things that matter to you the most, and continue doing them while adhering to social distancing. Talk to the people who are more quiet than usual, the people who come from the staff room teary eyed and most important of all, take care of your mental health.
NEVER FORGET THE KINDNESS OF OTHERS
I will never forget this- from my wife to my work place colleagues to the random salesmen who said thank you and supported me through this.
BE PREPARED
This will end one day. But never forget what happened. We might be in a position in which we can prepare ourselves and our trusts in a better way by reflecting upon what we learnt in this pandemic.
I, Omar Alam ST3 trainee registrar in Scarborough Hospital will always be there for you - wherever you are in the world.
My email address is:
dromaralam@gmail.com
My facebook ID is:
https://www.facebook.com/omar.ay.37
You have seen the news, you have seen the statistics. You cannot change this. However what you can change is your approach. And by this I mean:
PLANNING:
1. Make a will.
https://www.gov.uk/make-will
This is important especially if you have dependents.
2. Ensure your NHS pensions is updated with a nominee ( if it is not your spouse)
You can find this information here:
https://www.nhsbsa.nhs.uk/nhs-pensions
BRING CHANGES WHICH WILL MAKE US SAFE
We know that PPE helps. We know what the official guidance by PHE and WHO are. Follow them! Also talk to your management if you are worried.
REMEMBER THE PEOPLE WHO WALKED OUT OF HOSPITAL
In my case, a 85 year old plus patient walked out of hospital in a week despite being unwell.
TAKE CARE OF YOURSELF
If you become symptomatic, self isolate. You are not only putting yourself at risk but patients and colleagues at risk.
The rota will go on, they will find people. Do not worry.
BE KIND
This is the time to learn empathy, kindness and love. Be it your colleague or a family member. Or a random elderly neighbour whom you help with shopping, never ever stop being kind. This is the only thing which will get us through this pandemic.
GIVE YOURSELF A BREAK
Have I broken down? Yes
Have I got up? Yes
This was only possible by taking a break - luckily I was off for 3 days after having an argument with someone and the break helped me vent and also reflect upon this situation.
APPRECIATE EVERYONE
It is not only NHS workers who are working hard, it is their spouses, their children, it is the avid mountain climber who is social distancing at home, it is the smoker who has quit because he wanted to avoid spreading it to others by smoking on the pavement, it is the bus drivers, the taxi drivers, the cleaners, the garbage men, the people who have now become unemployed because they had to close their pubs/restaurants. Every single member of society has played an important role!
OUR MENTAL WELL BEING
We will break, some of us will suffer from PTSD. Find the things that matter to you the most, and continue doing them while adhering to social distancing. Talk to the people who are more quiet than usual, the people who come from the staff room teary eyed and most important of all, take care of your mental health.
NEVER FORGET THE KINDNESS OF OTHERS
I will never forget this- from my wife to my work place colleagues to the random salesmen who said thank you and supported me through this.
BE PREPARED
This will end one day. But never forget what happened. We might be in a position in which we can prepare ourselves and our trusts in a better way by reflecting upon what we learnt in this pandemic.
I, Omar Alam ST3 trainee registrar in Scarborough Hospital will always be there for you - wherever you are in the world.
My email address is:
dromaralam@gmail.com
My facebook ID is:
https://www.facebook.com/omar.ay.37
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