Rosemary Clarke: Nursing as a junior doctor

Rosemary Clarke describes how time spent supporting a nursing team can make junior doctors more confident in their bedside skills

The covid-19 pandemic has been ever present throughout my short medical career. I graduated from medical school in 2020 and was expedited into the profession as a foundation interim doctor in May, before starting as a foundation year one doctor in August. When covid-19 cases surged again this winter, I was redeployed to support the nursing team in the intensive care unit (ICU).

I work at a “surge centre” hospital in London, and the second wave caused a tripling of patients in the ICU. When I moved across, there were 90 patients spread over three floors: spaces for patients had to be created between formal beds. 

I felt a sense of chaos and panic when I first started. I was apprehensive about the scenes I would be faced with, and my unease was exacerbated by the feeling that I had few skills to equip me for this environment and role. I had been a healthcare assistant before medical school, and frantically tried to recall any knowledge from this period some seven years prior.

I was quickly in awe of the ICU nurses. They were in impossibly high demand, yet were able to manage patients (sometimes up to four) in great detail. They titrated all organ support including vasopressors, haemofilters, ventilator settings based on arterial blood gas results, as well as sedation and analgesia. From the cardiac monitor and blood results, they made decisions on giving electrolytes (at concentrations and rates that were extraordinary to my ward based training). They managed medications for all of their patients, and maintained vascular access lines. Their skills also included bedside care such as maintaining hygiene, repositioning patients, and aiding their comfort. The expertise and responsibility this role requires stands in stark contrast to the recent news of nurses receiving a 1% pay award this year. The pandemic has brought the debate around fair pay for nurses to the fore for the public, and the Royal College of Nursing has a campaign I quickly supported.

I felt embarrassed about my lack of ability to do anything practical in this role. Having become settled into prescribing fluids on the ward, I now found myself second guessing my ability to actually hang a bag up. I frequently prescribe antibiotics, but could I remember how to reconstitute them?

The nurses kindly taught me many skills. Having spent one clinical skills session preparing intravenous medications at medical school, I was grateful for their patience in refreshing my rusty knowledge. I also learnt techniques to protect airways when rolling patients, and how to most effectively clean patients and protect them from pressure sores. When working at the bedside, you’re the first person to pick up problems and troubleshoot them. If, for example, a patient suddenly starts to snore and gurgle it indicates a cuff leak, and prompt help is required.

These are skills I am glad to be taking with me when we return to our specialty rotations. I won’t be seeing cuff leaks, but being confident within the bed space empowers me in all aspects of my role as a junior doctor. I will still rely on the multidisciplinary team (as both a junior and in more senior roles), however I am returning to the wards as a more autonomous practitioner within my competencies.

Although I missed talking to patients (the majority I looked after were sedated), it has become even clearer to me that you gain a great insight into patients’ progress, status, and clues to their condition by spending extended time around them.

This pandemic has brought new challenges and large parts of our service have had to rapidly change. I am amazed by the diversity of the roles I have worked with as nursing support: a military technician, an outpatient TB nurse, a member of the finance department, a hepatology clinical nurse specialist, the head of the pain service, medical students, theatre nurses, senior ophthalmologists, and a deep sea diver. Everyone has adapted to address the needs of this crisis—learning new skills as well as bringing their own. I was glad to let the nurses know I could review the normal ECG from the bedside, for example, and when a cannula tissued, I was keen to replace it.

In this time of great sadness, trauma, and hard work, which many of us have spent in roles outside of our comfort zone, is there anything to take away? The pandemic has highlighted to me the importance of maintaining diverse skills as doctors, and has been an opportunity to learn from and experience the roles of the multidisciplinary team. I am grateful to have met many inspiring and kind colleagues, been of use to the intensive care staff, and to be reminded of my appreciation for everything that nurses do. 

Rosemary Clarke is a foundation year one doctor working in North London. 

Competing interests: my partner is a midwife, and so is also covered by the NHS Pay Review Body. I could thus indirectly benefit financially from support for the Fair Pay for Nursing campaign.