Coping under pressure

I recently had a terrible week at work, I was put onto an unfamiliar ward instead of my normal one, so the staff, workflow and environment was completely new to me. All the usual doctors are on leave or on call and I am supposed to have another junior help me out (who is also new) but he was off sick for the entire week... everything that could go wrong, did went wrong. Now that I survived that ordeal, I took time to reflect about my performance working under pressure.

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Acknowledge your limits

During my first day, I immediately introduced myself to the staff members, letting them know that I am new to the ward and that I will be on my own. Fortunately, they were nice enough to take a few minutes to quickly show me around the ward: the staff room, toilets, clinical room, bays. They also explained to me the usual way ward rounds are carried out and when the consultant would come in (only on two days of the week, juniors do their own ward rounds on the remaining days). The consultant was also understanding and appreciated the fact that I may be swamped so he ensured I have his mobile number so he was readily contactable, and also bought me a drink to start the day with.

Had I went in like any other normal day, I probably would not have received all these useful information and built relationships with the team, leading to a lot more problems down the line. It was also important that I held realistic expectations of the workload and my abilities so that I know how much I can feasibly achieve within my working hours, and therefore the need for prioritisation.

Creating your own structured workflow

I started doing my ward rounds and I remember being rather disorganised for the first two days. A lot of electronic notes were copied and pasted without being updated, medications were not reviewed thoroughly and plans were not specific enough. While this did speed up the ward round, it came at the cost of pharmacists and nurses constantly coming to clarify various parts of my documentation and management plan, which wasted more time than it saved. I started paying a lot more attention during the ward round, and took reasonable amounts of time reviewing the patient's admission and progress systematically. I ran through the diagnosis/issues, the clinical observations, blood tests, imaging and finally assessing the patient. I ensured my documentation is up to date and ensure plans are clear and specific, if necessary I would let the nurses know there and then. This might sound like a typical day on normal ward, but it really surprised me how quickly I lost that structure when put under pressure- something I would try to ensure not happen again.

Time for a break

I am the kind of person who tends to get overly absorbed in work, and this certainly backfired on me. I was tired and exhausted at the end of the first day, having only realised I missed lunch when walking out of the hospital. In hindsight, it probably would be entirely feasible to grab a quick sandwich- if I needed to, I could even eat this while doing something like reviewing blood tests at the computer desk. Try not to have your BMs lower than the hypo patient you are treating.

Escalate

In cases where your pressure comes from a managerial issue, and there is potential for this to be resolved, definitely let the people in charge know. I made the rota coordinator aware of this poor staffing early on, and a locum post was advertised each day. Consultants from other medical wards also occasionally sent their juniors over for half a day or so to help out, which was much appreciated. Ultimately, you are caring for patients and you should always prioritise their safety and comfort. If it comes to the point where you realise that you are at wits end and may pose a risk to harming your patients, there should always be sufficient support for you, after all, you are only one person in this entire system and should not be expected to deal with everything on your own.

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Have you ever been put in a stressful situation on the wards? How did you cope with it? Share your experiences below.