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The Junior Doctors Survival Guide written by Nurses

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Well done. Congratulations. You’ve survived medical school and made it ‘on to the shop floor’, this is where the real test begins.

Your first few weeks as a Junior Doctor are going to be difficult and jam-packed; a new hospital, new colleagues, new patients, and a new hospital system to figure out.

Here are ten tips that will stand you in good stead for your first day, week, month, year and beyond. This is your Junior Doctors Survival Guide as written by Nurses;

  • Respect the nurses. You can come to us for advice and guidance – we will have you back – but please don’t take us for granted. We have an abundance of knowledge about our patients, the hospital and how to make stuff happen.
  • Each member of the team is important. Doctors, nurses, porters, physiotherapists, domestics, estates, plumbers – the hospital simply couldn’t function without them.
  • Don’t be a smart arse. We know and understand you have worked hard through medical school and congratulations on becoming a Doctor, but now it’s time to get to work.
  • Have a sense of humor. Make sure your able to have a laugh and a joke but be careful not to cross the line.
  • Master cannulation. I don’t just mean know how to put a cannula in – develop the skill and master it – it will stand you in good stead for the future.
  • Eat and drink. The list of jobs is, and always will be, almost endless. Make sure you take your breaks; eat, drink and chat to your fellow colleagues.
  • Show emotion. I’m not going to lie to you, it’s going to be hard – medical school hasn’t prepared you for the first few months of life as a Doctor. If you’re having an especially tough day talk to someone about it. Don’t beat yourself up for having a little cry – it happens to the best of us.
  • Don’t just look at the numbers. We spend 12 hours a day with our patient, we will come to you when “something just isn’t right”, we don’t know what, we can’t put our finger on it. But, we know our patients.
  • Your first death is hard. Expected or not, nothing can prepare you for the death of your first patient. We have all been through this. See- show emotion and How to Deal with the Death of a patient
  • Tidy up after yourself. Nothing and I mean nothing, annoys the ward staff more than a Doctor who thinks the staff are there to clean up after them. Tidy away your sharps, notes and coffee cup.
  • Ask for help. Your seniors are there to support you – it’s literally their job. Don’t be afraid to escalate patients or situations to them and never put yourself in a situation where you have no backup.
  • Admit when you simply don’t know. Making up an answer to a question can have serious consequences. If you don’t know. Say, but find out.
  • Try to go home on time. Look through your list – find out what can wait until tomorrow. Your downtime and social life are important too (check out our list of NHS Discounts for downtime ideas). You work to live not live to work.
  • The hospital at night is scary. There are fewer doctors, nurses and seniors around to support you. Call for help early and escalate appropriately.

Remember, you are part of our team. Our job is to work together in the interests of patient care. We will try to look after you, make you tea when you’re sad and, rest assured, we will tell you when you’re being an idiot.

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How to write in Nursing Notes

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The Nursing and Midwifery Council (NMC) Code of Conduct states that we all must “keep clear and accurate records”.

Documentation and record-keeping featuring is a prominent feature in within the NMC Code of Conduct. It is your duty as a nurse or midwife to keep your notes up to date, not only to protect your patients, but also to stay on the right side of the law.

Sub standard record-keeping is one of the top five reasons for nurses being removed from the NMC register. You should consider your nursing notes as evidence of the care you have provided and will act as a reminder in the even of a complaint or investigation.

The famous nursing proverb is; ‘If it’s not written down; it didn’t happen…

Here are a few core guidelines you should keep in mind when you write notes on any patient:

Write as you go. The NMC says you should complete all records at the time or as soon as possible. Try to avoid leaving your nursing notes to the end of the shift – write as you go. This will ensure everything you document is fresh in your mind and therefore accurate and up-to-date.

Use a systematic approach. Try to use a systematic approach to documentation; ACBDE, SBAR etc – this will help ensure your notes are both detailed and accurate. A good methods is to; describe what happened, provide your clinical/nursing assessment and finally explain what you did about the situation.

Keep it simple. Nursing notes are designed to be quickly read, so the next shift can be caught up to speed on a patient.

Try to be concise. Writing a few lines can sometimes provide more information than writing a whole page.

Summarise. Don’t duplicate. If you have already documented a full assessment in other nursing documentation you can summarise this rather than duplicating it – your just creating yourself more work.

Remain objective and try to avoid speculation. Write down only what you see, hear and do. Try to avoid speculative comments unless they are relevant to patient care such as consideration to future care.

Write down all communication. Any discussions you have had with family, doctors or other healthcare professionals should be documented in the nursing notes. You should also document the names of people involved in discussions.

Try to avoid abbreviations. Write out complete terms whenever possible. An abbreviation can mean different things in different areas. Your trust should have a pre-approved abbreviation list.

Consider the use of a scribe. Emergency events such as cardiac arrests, trauma calls or medical emergencies commonly have poor documentation. Consider appointing a member of staff to write things down as you go; times and doses of medications, medical reviews, clinical interventions etc.

Write legibly. If nobody can read your notes there isn’t much point in writing them at all.

Finally, you should ensure your documentation is clearly signed and dated. Student Nurses or un-registered staff may need to have their documentation countersigned – you should check your local trust policy.

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What is the Naylor Report?

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The Naylor Review or Naylor Report is a set of asset efficiency recommendations by Sir Robert Naylor – a former NHS leader.

Summery: the Naylor Report is a 46-page report published on March 31 by Sir Robert Naylor, former boss of the NHS trust that runs University College London Hospital. The Naylor Review looks at how efficiently the NHS uses its land and property. It concludes that some NHS assets should be sold to fund NHS improvement.

The basic message of the Naylor review is that some NHS assets should be sold in order to improve others.

The report firstly highlights that the NHS is under severe financial pressure. The Naylor Review states that the NHS doesn’t have enough money to invest in things like buildings and equipment and the purpose of the report is so see if property can be used more effectively.

The report looks, makes the controversial recommendation that, selling some of the property may be the best thing to do when looking at a sale v cost to maintain system.

The report estimates £2.7 billion could be made from the same of these assets — more if things like planning permission went the right way.

There is no suggestion in the report that this is intended would affect existing NHS services. Although the primary criticism of the report is that that it’s success would depend on how well the report is implemented and if funds would be used to improve currently services.

Theresa May confirmed in an interview that the government supported the independent review’s recommendations.

You can read the Naylor Report on the Gov.UK website – be warned, at 41 pages, it’s not exactly bedtime reading.

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