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It took me more than a month, almost towards the end of my second month in my housemanship / internship journey before I started my shift as “ON- on night“.
“ON” is from 7pm – 8am and is the overnight shift taking care of wards. Depending on the ward that you are being allocated to, it is either the “Male Orthopaedic Ward, MOW” or the “Female Orthopaedic Ward, FOW” as well as the “Paediatric Orthopaedic Ward, POW”. However, POW is mainly passive calls. Thus, indirectly, you would be in-charge of two wards.
I started my first shift late because I was due to “off-tag”. I have attempted my off-tag assessment numerous times prior to my first shift and failed each and every one of them. Hence, I was not deemed fit to begin my first “ON” shift. In a way, I was glad and thankful. I felt protected because I was afraid of the weird things that could occur at night. I simply did not know how to handle or attend to them. Sadly, that also meant that I was simply hindering myself from learning. I was not mentally prepared and I was just simply “scared”.
However, I started. Before I proceed to my advices and tips on surviving being the “on night” in this posting, allow me to brief you on how a typical night would be like as an “on-night” house officer in the Orthopaedics posting.
As mentioned, the shift begins from 7pm and lasts till 8am. Most of us come at 7pm on the dot and receive handover from the “LD – Long day” person or the “tagger”.
Next, we proceed to check if the on-call review has been completed. This is part of the task of the “LD” house officer or “tagger”. However, sometimes things do not go according to plan. Thus, if it is not completed, it’s time to start.
On-call reviews are usually done twice, one with just the medical officer and the following one with the medical officers and specialists by the medical officer on-call in charge of wards for that particular day as well as the specialists on-call. The beds reviewed are usually the beds situated in the acute area as well as newly admitted patients from the emergency department.
This is followed by carrying out any necessary joblists from the on-call review. After the on-call review, there is usually a “free” period before you get “cc-ed” or called to the emergency department. It is mentioned in previous articles, we will get “cc-ed” or called from the wards to help carry out the active joblists of the stranded patients. It’s just how the system is in this department. Anyway, it is during this time that most of us begin our “coming mornings“.
Depending on the speed of how you work multiplied by the amount of coming mornings, is how quickly you can take a break for the night. Naturally, I’m slower than most people. Thus, I pretty much am on the move till the end of the shift.
“Coming mornings“ should only be sent after midnight. Hence, if you were to complete it before midnight, hold it till after. Always double check the patient’s name and ID on the forms and tubes as well as the gender, ward, date and time, signature, chop and relevant history (for some). This is to ensure that your efforts in acquiring the “coming morning bloods” are not futile. True, that the form and tubes are prepared by the morning set of doctors and technically it would be their fault should a blood investigation be rejected in the system. However, medicine is all about team work and though coming mornings may seem like a small menial task, it provides the information needed by the morning team for their continuous management.
Thus, bloods that are clotted or rejected in the system, it is necessary to repeat them again which only unnecessarily hurts the patient again and delays their management. It’s a butterfly effect. Hence, always be sure to double check, it is all for the patients and as part of our service after all.
So far, the night sounds pretty straightforward. However, that is not always the case. Usually, something happens in between during my night shift. The Paediatric Orthopaedic Ward (POW) does not have a house officer actively taking care of the ward after 5pm. Hence, should there be any acute issues, post-op reviews or transfer in reviews to be done, the staff nurses will call either the house officer form Male Orthopaedic Ward (MOW) or the Female Orthopaedic Ward (FOW).
It can be rather annoying at times. However, just remember that the staff nurses are simply carrying out their duties and it would be even more difficult if we had to personally check and see for any new admissions or post-op reviews.
Similarly, aside from “on-call reviews” and taking “coming mornings”, we have to attend to any acute issues in the ward that we are assigned to in addition to post-op reviews and transfer-in reviews. Such reviews are extremely important as well as patients have a tendency to bleed post-operatively or be in extreme pain after the anaesthesia has worn off. Doing such reviews ensures that the medications are served to the patient by ensuring that they are being indented and to carry out other necessary plans.
Finally, bed allocations. In the middle of the night, staff nurses may switch the patients’ beds. In addition to that, there might be new admissions. Thus, it is important to ensure the masterlist is updated before allocating the beds for the morning set of house officers.
Bed allocations are usually sent by 6am.
Usually by 6am, the morning team of house officers will start arriving and that is when the load gets lighter and most of us will safely leave the ward to clerk cases at the emergency department or carry out necessary active joblists that were not prioritised earlier.
Since our night shift ends at 8am, we might be “cc-ed” by the morning team to aid in acquiring certain sets of bloods which are sometimes missed or forgotten by the set of doctors from the previous morning shifts.
Once all is said and done, it is time to “close the shop” and return home.
Sounds pretty straightforward, doesn’t it?
I have always been intimidated by the idea of working as the “on-night” house officer an with exposure, I learnt how to manage certain acute issues.
It is scary because it is unpredictable. Thus, it is best to equip thyself beforehand.
1. Prepare your bed allocations before work
Bed allocations should be sent by 6am, do not send it too early as you might miss any new patients.
However, it is best to go through the masterlist before work and to draft out the allocations on your phone beforehand and to update them along the way.
2. Inform the next shift of their allocations
This is just an odd habit of mine. After setting the “KIV bed allocations”, I would personally message each house officer on the beds that I’m planning to assign them to.
This gives them a brief idea on the particular article that they would be working in and should things get rocky in between the night and no time to allocate and update the masterlist, there are still doctors who would come by 6am to review the patients.
3. Start your coming mornings EARLY
As early as possible. Just be sure not to get caught by the bosses of course.
Things may not always flow smoothly throughout the night. Thus, it is best not to take that short quiet period for granted and to just start.
4. Attend to EVERY post-op review
Post-op review is extremely important.
Never ever miss it.
5. Keep you ward MO oncall, blood bank MO on call and peri anaesthesia MO oncall on speed dial
Well, if you still use speed dial.
Basically, what I meant is to be sure you do know who is oncall and have their phone numbers saved. This saves time from having to call the operator or to scroll through the groups to haunt for them should there be any emergency in the ward.
Basically, that is it. It seems daunting at first but it actually provides a good experience. It taught me how to be more confident in myself in terms of managing certain acute issues more so than being in the morning shift.
However, remember that the odd things always happens at night. Hence, stay equipped and be prepared and enjoy the experience. There is just so much to learn in every area.
Till then, take care and all the very best!
Related Posts:
- How To Survive EMOT As An Orthopaedics House Officer – Housemanship in Malaysia
- How To Survive As An ETD / ED House Officer In The Orthopaedics Department – Housemanship in Malaysia
- Pulling Through My First Tagging Experience As An Orthopaedic House Officer – Housemanship Diaries
- My Daily Morning Routine As A House Officer In The Orthopaedics Posting – Housemanship Diaries
- The Orthopaedics Posting – Housemanship Diaries
- My “Coming Morning” Priority – Housemanship Diaries
- My Support System During My First Posting In Orthopaedics As A Junior Doctor In Malaysia – Housemanship Diaries
The Theoretical Doctor 