Have you recently joined the NHS workforce?
This page is aimed to signpost you to tailored sources of assistance in your new professional healthcare role. We understand the transition can be challenging even without the added strain of a global pandemic. Many of the resources allude to assistance for Medical Students who will start work as Foundation doctors. However, we also want to provide support to new qualified nursing graduates, midwives, physician associates, physiotherapists and pharmacists who may also need help, as well as others in new frontline healthcare roles.
First and foremost we want you to be safe, to feel safe and feel adequately supported. This may not be obviously evident in the demanding NHS environments you will be working in, as the whole system is under strain. We commend you on your ability to step up and take on the challenge. Now, more than ever, it will be important for you to prioritise your personal wellbeing; compassion must start with yourself. It is not selfish to embrace this fact.
For recently-graduated students working within Birmingham Health Partners organisations (University Hospitals Birmingham or Birmingham Women’s and Children’s) – we’ve assembled a group of doctors from the College of Medical and Dental Sciences who are happy to support students who want to talk about their experiences working in the NHS. You can reach them through the Student Services Centre – firstname.lastname@example.org – and this complements the normal wellbeing service.
Techniques to help with mindfulness and relaxation
Despite days where you will feel rushed off your feet, you will need to take time to reflect and consider if your aspirations and your values align with your role. It may take years for this to fully materialise, but don’t lose sight of what you value the most. For most, it is meaningful relationships and the hope of making a difference in the world. It is these values that will lead you to eventual fulfilment. You may not realise it, but you are already impacting peoples’ lives in positive ways. Take time to consider these questions:
- Why did you choose to work in healthcare? The ‘good’ you are going to do for your community (patients, and colleagues) in the coming months will be a source of pride although it feels daunting right now.
- How are you going to meet the uncertain future? We all have different abilities to tolerate risks and anxiety, but we can’t change all our circumstances. How can we re-frame the situation to make it feel less scary?
- How are you going to take care of you? Who are your ‘go to’ supports, the people you trust to have your back, no matter what. How are you going to help them know how to help you? Make those plans now – for example, virtual check-in times with your friends/family over Skype or Zoom. Know what your positive coping mechanisms are (e.g. exercise, art, music) and understand your negative coping mechanisms (e.g. alcohol, food).
- Are there any specific areas of the job that you feel you need to refresh before you start? Now is the time to do this. Could you create online groups to revise guidelines and patient management together?
Knowing yourself and relating to others is a really important component of professionalism. Can you identify what happens when you feel stressed? Can you begin to deconstruct the process and identify where unhelpful thoughts lead to unhelpful behaviours?
Unhelpful behaviours can have ramifications on all aspects of your life from your food and drink intake, habits, perceptions of yourself and the quality of relationships.
Here are some tips for building self-awareness and reducing unhelpful behaviours:
- Every feeling is a reminder of something important to us.
- Our feelings indicate to us what we value
- Anger tells us something is blocked; fear tells us about a threat; shame suggests we feel we didn’t live up to something important; confusion says we are missing something important
- Negative feelings signal a conflict between our values
- Many people ignore the message of these feelings and may repress or avoid difficulties or stressors
- It’s important to feel-through your feelings – feel, appreciate, grapple, and reconcile
- When we feel-through our feelings, we are more grounded and know what is most important to us
- With time, feeling-through in different contexts gives us resilience
- You do not have to put yourself in a situation where you will be in harm’s way. Taking care of yourself is the first priority before helping others.
- Be kind to each other; you are not in competition. If you hear that a colleague has been doing X,Y,Z and you haven’t, it doesn’t mean you should (or in fact that they should). This will not disadvantage you in your future career.
- We all have different skills and attributes as well as personality traits and levels of experience. If you feel out of your depth, it is ok to ask for help or to say no. Recognise what you can and can’t yet do and stick to it. We will all learn to do new things as time goes on.
- When you enter a new environment, let your seniors know you are there and ask them how you can help, know what specific role you have and what tasks need to be completed. If you are volunteering and realise that you may be surplus to needs, check if you are still needed, as it may be more useful for you to leave and help elsewhere.
- You may be part of a team managing extremely upsetting and traumatic situations. You are not responsible for decisions made in these circumstances, even if you are part of that team. Sometimes the emotional impact of these situations is delayed, and after a pandemic the support is still available.
- Know yourself. You will be upset, and tired at times – what do you tend to do now when this happens? Do you feel irritable, anxious, restless, or have impaired memory? What physiological indicators are you aware of? Do you get headaches, disturbed sleep, tight muscles? Know what things to look out for and ask a ‘buddy’ to look out for them too. Get them to ask if you are ‘really ok’ and make sure you act on any red flags indicating you need to take care of yourself as a priority. Even if that is a short break (to eat or drink), a stretch, some fresh air or a bathroom visit. Plan ‘me-time’ when you get home; recharge doing things you enjoy, exercise or talk to family and friends.
- Remember that carrying on when you need to stop isn’t heroic; it harms you, can harm patients and harm your team. We need to help you to be well; you are a priority. It’s ok to not be ok. Please do ask for help if you need it. You are in a unique situation and your senior colleagues really do know this. You might also want to think about how you could would be able to tell a colleague you are worried about them and that they need to stop and take a rest too.
- If you are ill then please do not go into work and make sure you let your team know as soon as possible. You are protecting yourself and others by doing this. This is the right thing to do, and you mustn’t feel guilty.
- Remember to keep information confidential. In stressful situations rumours can be passed on without being fact-checked, so also try to verify anything you share.
- Consider how to manage social media and news reporting. It’s important to stay connected and be up-to-date but a constant barrage of information can be disconcerting and use up your emotional energy. Pick times through the day to connect and others to switch off.
There is a lot of debate about whether, after experiencing a traumatic event, it is a good idea to debrief the team involved. Your trust may run Schwartz rounds, which are useful for exploring the emotional and social challenges of caring for patients. An alternative is a Balint group, which can be a reflective, cathartic way to offload feeling from difficult encounters. Other teams run HOT debriefs, focusing on facts and learning points in a supportive, no-blame environment.
However your team debriefs, remember it’s ok to talk to friends and colleagues about how you’re feeling but don’t insist on them reliving events (or feel pressurised to relive them yourself), as this can be re-traumatising.
If you do start to find intrusive upsetting thoughts, focus on distraction techniques, e.g. tapping your thigh, or use the methods in the graphic above. Thankfully most symptoms subside in time, usually in around four weeks. If they don’t, it would be a good idea to seek more professional support.
Useful links and resources:
- YouTube video on how to manage our anxiety about Covid from You are not a Frog
- PEARL Emotional and Psychological Wellbeing (PDF)
- BMA 24 hour contact line for students and doctors
- University of Exeter Care under Pressure resources
- Medical support for doctors
- Headspace App – NHS employees get 3 months free access to the app
- Unmind – unlimited access for anyone with an nhs.net email address
- Decision Fatigue
- Wellbeing resources, including staying safe during this pandemic
- iResilience – find out what what factors can affect you and get a personalised report for free
- Psychological first aid
- The Royal Medical Benevolent Fund
- Example of Hot Debrief 1
- Example of Hot Debrief 2
(Thank you to UoM clinical academics -Drs Emma Sahgal, Fiona Leslie, Aisha Awan, Rachel Lindley, Kurt Wilson, Susan Harris and Erica Sullivan who collated some of this written content for Manchester University Medical students)