Tips to Cope With the Challenge of Changeover Day

Siobhan Harris

Disclosures

July 28, 2021

Changeover Day is the first Wednesday in August when thousands of newly qualified doctors start and junior doctors' rotations begin. 

In past years the day has been heralded by media reports of new doctors being overwhelmed and out of their depth, coupled with warnings of the dangers of going into hospital on this day as a patient.

Medscape UK asked two health professionals what advice they'd give to make the day run as smoothly as possible.
 

Q&A - Internal Medicine Trainee

Dr Priyadarshini Bhattacharjee

Medscape UK spoke to Dr Priyadarshini Bhattacharjee, an Internal Medicine Trainee at Cambridge University Hospitals NHS Trust. She's an International Medical Graduate (IMG). We asked what she thought could be improved on changeover Day.

I feel that along with the starter packs sent out by the trust, there should be IMG specific guides and persons of contact who are well versed with visa-related queries and the updated norms of job appointment. 

The guidebook to common medical emergencies is an important book that I feel would benefit all junior doctors. I also feel that a ward-based or departmental induction should include information on where the crash trolley is located and which number, and how, to bleep if there is an emergency.

Juniors could try to find out who their seniors are, recognise who to ask for help, that includes the rapid response team, the outreach team, the registrars, and their own colleagues.

They should also try to find out about the nurses in charge as well, as they are very resourceful when it comes to providing information and guidance based on their experience. Not everything is 'just a clinically conclusive' event inside a particular ward and it is upon us to communicate well ahead so that our colleagues and staff know where we stand.

On the first day, I'd suggest my juniors turn up a little early, introduce themselves, and 'browse' through the patients in the ward. For example, eyeing the monitored beds before starting the ward round can sometimes help identify the sicker patients in the ward. Asking the nurse colleagues or the nurse in charge about any patient they're concerned about is also a nice start before the ward round begins. 

For paperless trusts, it is always better to get acquainted with the IT helpline number as they're available 24/7 for any software related or technical queries. 

There are colourful badges available like, 'Hello my name is' and 'I am new to the job, please be patient' which could speak louder than words and are very useful for introducing ourselves to people with hearing disabilities, which constitutes a vast majority of the older patients we see in the hospital. I found them late, but useful, as the bright yellow colour of my 'Hello my name is Dr Pri' shone through the gowns we had to wear in COVID ICU, and due to the tightly fitted masks, our voices are usually muffled while we speak. 

I would like all my junior colleagues to know that all of us started at some point. We went through a myriad of experiences that built us through each passing day. I would suggest they not be too hard on themselves and seek help if they're unable to cope and always ask questions. 

Q&A - Nurse

Anna Crossley/Credit: RCN

Anna Crossley is the Royal College of Nursing's Professional Lead for Acute, Emergency and Critical Care.

What challenges does changeover day present?  

We prefer to call it what it is – any other day.

Everyone has been 'new' to a role and usually most of us start our bright shiny newness in dribs and drabs depending on the organisation we work for. In medicine, this is a little different and a doctor’s extensive medical training culminates in most starting a new job as an FY1 at the same time across the UK in various hospitals - as well as FY2s that yesterday were FY1s and have usually moved to a new speciality. Being new increases the need for several things: time (time to learn, time to teach, time with patients); patience; the ability to read hospital signage and not end up in the basement; the realisation that when someone says 'Doctor' it is actually you they are talking to.

The challenge for healthcare, especially in the current pandemic climate, is that time is what we have least of. Nursing regularly talks of care left undone at the end of a working day – care we wanted to give service users so they are safe, their care is high quality, and the workforce is safe to provide that care. In your newness as junior doctors you will also have reams of to-do lists, ward rounds, places to be, things to execute, clerking to be done, endless computer programmes to log into and navigate, things to learn and you also don’t want to leave care undone. Strong nursing leadership and clinical expertise that week are paramount – to support you, escalate and safety net, as well as nurture you to be the best you can be in the first few days. The biggest challenge for everyone is a perceived lack of time and the need to remember self-care – we are after all human. We need to eat and drink, and go to the bathroom in order to function well and, although the ability to put both off for seemingly endless amounts of time comes with the job, it doesn’t mean you should.

How do nurses regard the day?

For many of us this is just another day amid the peaks and troughs of a life working in healthcare. Everyone has to learn and for all of us in the healthcare profession, learning is lifelong. Yes, we might edge the rota towards more Advanced Practitioners and strong clinical and leadership presence this week but, like winter, a new cohort of junior doctors comes every year and we embrace it.

Registered nurses act as role models for best practice in the delivery of nursing care but we play an active and equal role in the interdisciplinary team, collaborating and communicating effectively with a range of colleagues. In short, if we don’t know, we’ll probably know someone who does. What you can guarantee is that nurses know 'the system' in a way that cannot be learnt from a book; the challenges, the shortcuts, the pitfalls and the guaranteed successes regarding colleagues, regular patients and particularly local services.

The nursing profession comes with a huge scope of practice, skills and knowledge and we actually like sharing it. Nurses are the education experts in medical education. Advanced Practitioners provide continuity to services not just during medical changeover but throughout the year and will probably be teaching you as part of your induction. They share rotas in a multi-professional team, so the medical changeover is a little more manageable. They are your ally; in these uncertain first few weeks they are a constant and you can escalate patients for senior decision making to them.

What tips would you give to doctors to make the day run more smoothly?

We get it; we have been there ourselves. And yes, a little gentle teasing may come your way today as 'babies', 'baby docs' or 'house plants' but don’t be afraid. Come talk to us. We know the shortcuts, the easy way, the right person to ask in the right way, the phone numbers, the bleeps, the contents of the storage cupboard. We may give you a gentle hint like 'do you really want to prescribe that?' or say 'usually we do….' to guide you when needed - helpful to look out for this. The pandemic has seen a needed digital expansion in virtual learning. Flexible induction platforms could be sent to you prior to starting, allowing you to take a deep breath off site before your first day and feel you have some kind of handle on Day 1. Keep a diary or reflective journal during this time as you will never feel like this ever again. And if it isn’t plain sailing, who better to hold your hand on this momentous day in your career than a nurse? You may, like me, make lifelong friendships from your efforts and watch each other learn and grow.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....