In this blog series, Nikki takes over to tell us about her experience as a newly qualified physio and to describe the joys, fears and people she meets along the way. She'll also share her tips which might be useful to some of you too!
think I speak on behalf of most newly qualified physiotherapists that being on-call fills us all with absolute dread... If that phone rings, what will I have to deal with? What will my treatment plan be? What if I make the patient worse (!!)
Each Trust has their own on-call training policies, however I thought it might be useful to share my training experience and highlight the learning points I took away.
The Trust I work for run ‘Simulation Training’ where new members of staff are required to spend a day organised by experienced senior physiotherapists, as they take you through various scenarios in the Simulation Suit.
On paper the day seems just as daunting as the anticipation of actually being on-call. The Simulation Suit contains a ‘breathing’ dummy hooked up to an obs machine. A one-way mirror is mounted inconspicuously on the wall, concealing the members of staff who are controlling the vital signs and reactions of the patient. Oh, and cameras provide a video link to peers in the next door classroom, watching the scenario fold out….
What did I take away from the training day?
I think one of the most important, yet seemingly obvious learning points was to structure your telephone phone conversation. Although we cannot control what type of patient the referrer will hand over to us, we can ensure that we have gathered enough information on the telephone to make certain that we feel better prepared and more in control of the situation. The scenarios highlighted the simple things we may forget to ask for, such as the location of the patient! Even if we manage to take a really thorough hand over, that information is no use to us if we don’t know where to find the patient.
I anticipate that as soon as that telephone rings, my heart rate will rise and the panic will set in. So, in order to minimise stress levels as much as possible, make a prompt sheet with all the key questions you may need to know to avoid getting into a flap. The more information you can gather during the phone call, the more prepared you will feel. You can start pre-empting your assessment and treatment on your journey into the hospital, which may calm your nerves a little (and it allows some Googling time)!
When you arrive, don’t panic. Take your time, read over the notes and run through your clinical reasoning. For example, if they’re a surgical patient, have they had sufficient pain relief? Do they have reduced lung volumes? If so, how can you improve these? Observe the basics first, such as the patient’s positioning.
Ensure that you have consulted any other relevant investigations such as x-rays. In the past, I have received inappropriate ‘chest physio’ referrals for pulmonary oedema!
Finally, the training highlighted that it is important to establish early on the patient’s ceiling of care. With this information, it can be clinically reasoned whether physiotherapy is indicated as the most appropriate treatment or not. By prompting this conversation within the team, it may facilitate the MDT to consider other end of life pathways.
"I anticipate that as soon as that telephone rings, my heart rate will rise and the panic will set in."
Top tips (from someone with very limited experience!)
- Make sure you are up to date on your respiratory competencies as you will only feel more prepared and confident with your assessment and treatment techniques.
- If you get a spare half an hour at the end of the day, grab a fellow Band 5 and practice setting up pieces of equipment such as the IPPB machine.
- Prepare a list of questions you need to ask if you get a call out. I would recommend:
- Patient’s location, name and age
- The name of the referrer and their contact details.
- What treatment options have the team already tried and were they successful?
- The patient’s position in bed. If it is indicated, have the nursing staff attempted repositioning already?
- Has the patient had sufficient pain relief?
- Are they written up for nebulisers? If so, when was their last one? Perhaps the nursing staff could give them one whilst you travel in.
- Do they have a strong cough and if so, are they able to independently clear their secretions?
- Any recent investigations such as chest x-ray or ABGs. These add to your clinical picture.
- What is their ceiling of care?
A structured communication technique which is used amongst healthcare professionals is SBAR (situation, background, assessment, recommendation). It provides a template for a concise handover in which the main information will be included. Personally, I have found it useful to follow this acronym when I am handing over to other members of staff. When applied to an on-call scenario, this might be handing over to the ward physiotherapist in the morning, the nurse in charge or the medical team looking after that patient.
"The Simulation Suit contains a ‘breathing’ dummy hooked up to an obs machine. A one-way mirror is mounted inconspicuously on the wall, concealing the members of staff who are controlling the vital signs and reactions of the patient."
How did this particular training day benefit me personally?
Experiential, hands on learning
It is experiential knowledge that has been indicated as key for individuals to make wise professional judgements. Although at this stage of our careers, we have less exposure and clinical situations to draw on, for me, getting hands on is the best way to learn. Although daunting, the day was valuable as it allowed learning through experience and then reflecting on it afterwards.
The structure of the day allowed for peer discussion to take place. Following each scenario, the senior physiotherapist lead a debrief. Evidence suggests that peer discussion provides a forum for students to recognise their own emotional reactions to clinical situations through collaborative learning. It was evident that, following my own scenario, my peers facilitated my own reflection. By pooling collective experiences, my own understanding of particular scenarios was enriched and this will hopefully help with future learning.
I hope that I have parted with some useful advice. Often, it is the anticipation of waiting to be called out, combined with a fear of the unknown which is the worst part (although my phone is yet to ring)! It doesn’t matter how much preparation we do, I think it is only natural to feel anxious about our first on-call!
About the author
Nikki is a newly-qualified physiotherapist with a previous degree in Human Communication Sciences, currently working in a busy university hospital in East London. She was the first ever to sign up to one of our seminars when we started back in 2015; now a year down the line, she's our first ever resident blogger! Expect to see (and read) more of her very soon!