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Five ways to improve junior doctor morale

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    Bilal Sahib

Dissatisfaction among junior doctors has reached unprecedented levels: 80 per cent feel excessively stressed, and the number progressing directly to specialty training is declining.

Some of the solutions to this can only be implemented at a national level, for example, increasing the number of medical school places. However, these changes take time to create an impact. Locally implemented ‘quick wins’ could help to improve the morale of today’s workforce, thereby improving retention, productivity and patient safety. Here are a few ideas based on my experience as a junior doctor over the past two years.

Better rota planning

In the last twelve months I have worked in A&E, paediatrics and general practice in two different parts of the country. In theory, work schedules (rotas) should be released six to eight weeks in advance, but they are often late and are subject to last-minute changes.

I’ve received desperate requests for shift swaps from colleagues – for example, who have been rostered to work on their own wedding day – and it is common practice to be swapped onto nights or called back in to work at a moment’s notice.

It would be a great help to have the contact details of rota co-ordinators before starting a job. Accommodating leave requests in the rota rather than relying on individuals to swap would be much fairer. And distributing rotas with the advised six to eight weeks’ notice would help doctors in advance would help with planning other commitments. In future, using dedicated rota software would avoid human error.

Induction

Shadowing before my first job in psychiatry prepared me well for that role, but not for my acute medical job four months later. I went on my first ward round not knowing who anyone was, and my ‘smartcard’ was not set up to order tests. I was fortunate not to have started on a night shift, where I would have had only the support of a skeletal out-of-hours service. It is unsurprising that junior doctors can feel isolated and unsupported.

A mandatory, local, clinically focused induction should be arranged at the start of each new rotation, with locum doctors arranged in advance to ensure all new juniors can attend. This could be supported with a departmental ‘induction pack’ – this was invaluable to me in my last job, detailing essential information about the department, shifts and computer systems.

Rest facilities

Night shifts usually last around 13 hours for up to four consecutive days. However, quiet, private break rooms are rarely available, and when they are, staff may be charged for their use. Having a 15-minute nap during breaks has been recommended by a leading consultant in sleep medicine, but I find these difficult to achieve on a cold, unclean sofa in the doctors’ mess.

Long commutes are inevitable as training deaneries cover vast geographical areas, and 50 per cent of anaesthetic trainees have had a near miss or accident when driving home from a night shift.

Quiet, clean rest rooms should be available for staff to help avoid dangerous fatigue overnight, and staff should be encouraged to use these rooms after a night shift if they do not feel safe to drive home due to tiredness.

Out-of-hours support

Junior doctors working out of hours are contacted through a ‘bleep’ system, so that they can be reached anywhere across a sprawling hospital site. Answering a bleep requires interrupting workflow, finding a hospital phone, and calling the displayed extension number – by which point the bleep-sender may have left.

This system makes it impossible to prioritise work – while attending a cardiac arrest I was once bleeped to re-write a drug chart and prescribe an antihistamine.

‘Bleep screening’ senior nurses, who triage job requests to appropriate members of staff, have an invaluable role to play out of hours and could be more widely adopted. Portsmouth Hospitals NHS Trust has employed bleep screening, and sends jobs to clinical staff via a smartphone system rather than by bleep, halving the number of incidents putting patients at severe or moderate risk of harm in the first year of implementation.

Debriefs

Junior doctors rarely work regularly with the same on-call teams, and due to the short length of rotations they often feel poorly integrated within the multidisciplinary team.

I have often felt physically and mentally drained after managing multiple unwell patients, but it is hard to ‘shut down’ to get restful sleep before returning to work 11 hours later. Informal breakfast debriefs at the end of a run of nights could allow teams to decompress, reflect and air anxieties.

Work from the Fund has already identified frontline difficulties that erode staff morale and has noted that more could be done to draw on the experience of junior doctors, who are well placed to compare and contrast practices in different hospitals. But – to quote from the report – 'this requires trust leaders to genuinely value junior doctors’ insights and to challenge the hierarchies and tribal divisions that are longstanding barriers to teamworking’.

I hope this blog highlights some of the opportunities at a local level to make meaningful improvements to junior doctors’ working lives, despite the wider macro-political and economic climate.