1. Thou shalt have a basic grasp of mathematics.
You are looking after between seven and twenty patients. Your FY1 is looking after a minimum of 96 patients. She is entirely within her rights to growl when you try to tell her that you are “very busy”.
2. Thou shalt learn how to read a EWS chart.
The score for BP is for systolic BP, not diastolic BP — a diastolic BP of 8o does not trigger an urgent clinical review, no matter how many times you try to tell me that it does. The nausea score is not part of the EWS — you cannot decide that a patient whose obs are all normal is scoring EWS 3 because they were sick three times. And if a patient has had their parameters adjusted, you need to observe the new parameters — your FY1 is unlikely to be impressed with your long-standing COPD patient’s SpO2 of 91%.
3. Thou shalt put non-urgent jobs on the non-urgent jobs list.
You do not need to page your FY1 to rewrite a Kardex.
4. Thou shalt not put urgent clinical reviews on the non-urgent jobs list.
A review of a patient with a new tachycardia does not belong on the non-urgent jobs list. A review of a patient who has dropped her systolic BP by 40 in the last hour does not belong on the non-urgent jobs list. A review of an unconscious patient with a blown pupil does not belong on the non-urgent jobs list.
5. Thou shalt not harrass.
It is a waste of your time and your FY1’s time when you page her “just to check whether you’re coming back to the ward” or “just because we haven’t seen you yet today”. She has not forgotten that she is covering your ward and she has not gone for coffee. If you have not seen your FY1 for a while, it is because the brown stuff is hitting the fan somewhere else. The only way your FY1 knows that you are paging her with a stupid question rather than a properly sick person is if she stops what she is doing and calls you back, and if you are the third person to pull your FY1 away from a properly sick person just to tell her that it’s been a few hours since she looked at her non-urgent jobs list, she will be rude to you and she will not apologise later.
6. Thou shalt learn how to use a telephone.
Do not page your FY1 and then walk away from the phone. Do not page your FY1 and then pick up the phone to make another phone call. Do not page your FY1 to the paging system.
7. Thou shalt not expect on a Saturday that which can (and should) wait until Monday.
You may be right in thinking that your patient’s high blood sugars, which have been high for a fortnight and which they are asymptomatic of, are steroid induced, but your on-call FY1 is not going to make a unilateral decision at the weekend to stop steroids that they were started on by a neurosurgeon for their brain tumour.
8. Thou shalt use SBAR.
The on-call FY1 has never met your patients before. If you ask your FY1 to review a patient, she will expect you to know why you want them to be reviewed, what their current obs were, what their obs were before that, and whether a plan has been made by their day team. If you ask your FY1 to review a patient urgently, she will expect you not to have gone on your break in the three minutes it takes her to walk up the stairs.
9. Thou shalt read.
If you ask your FY1 to prescribe analgesia/anti-emetics/fluids for your patient who is, quote, not written up for any, your FY1 will assume that you have actually checked and will be unamused when she comes to the other end of the hospital and opens up the Kardex to discover that you had not checked and that those things had been there all along.
9. Thou shalt realise that it is in your best interests that your FY1 does not keel over in the middle of the ward.
If your FY1 says at 6pm that she is leaving the ward to buy lunch and will be back in five minutes, do not block her path and ask her to “just…” unless your patient is actively trying to die. It is at this point more important for her to treat her own hypoglycaemia and acute renal failure than it is for her to treat your patient’s nicotine withdrawal.