To think my NHS department is toxic?

[Thecolourandtheshape]

I work in the NHS as a doctor. I graduated last year. This is my third job and at the moment I'm stressed up to my eyeballs by the disrespect shown by my seniors.

Firstly, there is no fixed morning ward round. My registrars come to the office one by one and very quickly run round all the patients without giving us time to write down the plans or ask any questions. Then they'll text us throughout the day, giving us jobs they've just thought of, or asking for results they're perfectly capable of looking up on a computer themselves. Later in the day, various consultants appear totally at random and expect us to drop everything and do their ward rounds. They change the patient plans and suddenly give us a whole new set of jobs, usually including urgent scans that we then have to argue with Radiology to do. Then they go to theatre and are unavailable unless they want something from us.

Then the registrars and lower grade surgical trainees appear throughout the day, demand we stop whatever we are doing and come to "catch up" and go over what jobs we've already done, further interrupting us. I once had four "catch ups" with different seniors in the space of 2 hours, which wasted an insane amount of time and was immensely frustrating.

I have no control over my work or the structure of my day at all, and I'm constantly being dragged from pillar to post, e.g. sent to take bloods at 4pm on the other side of the hospital because my senior has changed their mind and suddenly wants them, and now I've got to hand over chasing the result to the pissed off night team.

The nurses in our team have their own office. We don't. But if we don't sit in the nurses' office and go to find a PC to use, they spread rumours we are shirking our duties. So the only alternative is to sit there and infantalise ourselves by asking to please borrow "their" computers.

Meanwhile the nurses in our team gossip viciously about everyone. I've been told incredibly unprofessional things, including some racist comments, and personal issues e.g. comments on X staff member being off with stress and how they're "milking it", comments that the consultants don't like a certain registrar, and comments that one of my colleagues is weak and doesn't appear to understand English (which is utterly baseless).

The consultants don't even know my name. I've worked here for nearly 4 months and the other day I was mistaken for a student, then asked what my name is. Another consultant thought I only started this week. They don't ask me about myself or even say "good morning" to me. They say "good morning" to the registrar and look through me. One of them has only ever spoken to me to shout at me.

I'm running around for 10 hr shifts being treated like shit on everyone's shoes. Today I didn't have lunch until I'd been working for 7 hours, and only because I absolutely insisted on taking my break.

I'm just so tired of the disrespect and chaos of my day. If they cared about me even slightly, they wouldn't treat me like this. Sometimes I wonder if I didn't turn up at work one day, would they even notice? Or would they just be pissed off that there's no one to drop their shit jobs on?

Spent all day mentally taking deep breaths and trying to focus on making my patients happy. But the more tired I am, the less I have to give, the more I go into myself. A patient cried today as I took blood from her, and I felt like the worst person in the world for upsetting her, but if I hadn't taken the blood I'd get it in the neck from everyone above me. I don't even really know my patients beyond what operation they've had.

Sorry. I'm so tired

I'm sorry OP, I have no useful advice but I just wanted to say that I'm sorry it's so rubbish after all the hard work to get to where you are. I'm sure your patients appreciate your hard work (even if they don't always say so). I hope someone will be along with some helpful advice.

Sorry things are bad for you. Some Consultants do seem to treat juniors like this and others are great. Maybe you have just been unlucky on this placement. Nurses gossiping, well yes I'm not surprised at that having Nursed for 30 years ! certainly racists comments are completely unacceptable and you should have a word with the ward manager regarding that.

That's awful. You really shouldn't have to put up with that. As a nurse of over 20 years I thought there had been a bit of a culture shift within the NHS over recent years and less of a hierarchy but clearly not in all hospitals!
Do you have to give any feedback for your seniors? 360 reviews?
It must be hard summoning any enthusiasm at all going into work each day in that environment.

That's shit, I'm so sorry you're experiencing this. I'm a mental health nurse and although our wards are often absolute utter chaos and the work loads for everybody unmanageable, the nursing teams have always been very careful to really look after our junior docs, especially the FYs. I've always felt sorry for you moving jobs so frequently and the amount stuff you're expected to instantly know, we're lucky to work in teams where we support each other (mostly) so the least we can do is extend that support to you guys. I really hope your next job is different and you're welcomed into a team. Until then, just do the best you can and know that not all teams conduct themselves in that manner.
(I'm still friends 15+ years later with FYs that are now consultants, they're fabulous people as I'm sure you are too)

That seems truly awful and not a healthy environment at all . The whole thing seems to stem from the consultants thinking they are gods and everyone treating them like gods so they are used to people jumping to their every whim .
I think you need to find out if all departments are like yours . Do you have one to ones to express your concerns ?

choices , move departments, suck it up knowing it's not forever , kick back and be assertive about your needs .

It sounds horrible. Are you FY1 or 2. Are you able to look for another job. Which part of the country are you in. Ours is a cardiac dept and the seniors are supportive, the nurses are too busy to gossip and the teams are organised.

Sounds horrendous definitely not happening everywhere. Our ward does twice daily rounds one consultant led and the doctors have an office with computers! AHPs don't but we borrow the nurse / Drs. Maybe a bit of feedback to your deanery is needed???

I’m sorry you’re going through this, it sounds awfully tough.

I have worked for the NHS in a management role but based within a specific clinical department and honestly it was the most toxic environment I have ever worked in. The nurses were almost all unbearably bitchy and gossipy and I heard numerous racist comments, the senior doctors were almost all unbearably rude and arrogant.

Other staff assured me not all departments were like this. How long will you be in this particular area? Is the end in sight?

Ortho? I fucking hate Ortho 🤣

that’s so outing if anyone from my trust is on here. It’s not a secret how much I hate it/them. The hiarachy 😫 one of my other student friends got shouted at by the consultant in theatre yesterday. 🙄

sounds like your possibly an FY1.

i promise it gets better. Are you due to move on soon or august? The end is in sight.

is it what you want to specialise in? I promise not all specialities are the same. Where I am, Obs and Gynae are always lovey to the juniors, as are Plastics and General. I’m sure it’s different in other places. A different person from my cohort raves about how wonderful cardiology is.

and you just have to be brave in A&E. It’s mayhem. But the nurses will always have your back, so I’m confident you aren’t in A&E.

rant away. But I promise now it won’t last forever. You’ve got this!

I have been where you are OP...from what you've said you are FY1 in a surgical specialty. Unfortunately surgery is like this in many hospitals. My job wasn't quite as horrendous as you're describing but it came close at times. The big difference was the team spirit from some people both nurses and doctors which made the rest bearable. I remember stomping into the rota coordinator's office one afternoon in tears to demand the leave I'd just been refused, after yet another consultant had wandered onto the ward to go through his patients at 4pm with no regard to the fact that I'd yet to have lunch or actually get anything done because of all the seniors doing the same thing all day long!
If you've been there nearly 4 months you must be about to rotate? Some junior doctor jobs are the total opposite and you'll love it!
The only way to make things better is to speak to your foundation programme lead and give feedback so that the placement improves next time. Ideally your educational supervisor could help but presumably they're one of the consultants causing problems too.

Sounds chaotic. I work in ICU. Consultants on our unit know us all by name. But then they have to. We have seriously ill or badly injured people to keep alive, often by a thread. You can't start shouting or ignoring qualified staff in that environment. My advice : look for another position.

Have you got a freedom to speak up champion you could speak to?

Or an Act as One contact? This really shouldn't be happening and if you get to the point that you burn out and leave the trust or even medicine, it's wasting public money. Retention and attraction is having a big drive at the moment. Our Trust has put the above in place to try stop staff leaving.

I would look for another job and complain to your freedom to speak up guardian about the toxic culture and how badly you are treated. This is appalling. My team would never treat you like this.

Thanks for the replies.

I can't apply for another job as I'm in training and have to complete this to progress (3 months left). Won't give details on department but I'm an out of sync trainee.

"after yet another consultant had wandered onto the ward to go through his patients at 4pm with no regard to the fact that I'd yet to have lunch or actually get anything done because of all the seniors doing the same thing all day long!"

Yeah that's painfully familiar.

I honestly, truly think they should have all their F1s and F2s removed and be left to deal with their own shit. I'm not receiving any training other than how to be a subservient servant.

The NHS needs serious reform, very quickly. It is sounding its own death knell with its behaviours, ridiculous practices and protocols.

I'm so sad to read this. Are you in your third job ie F1 third rotation? Have you spoken to your medical education dept, FPTD? In the absence of those I will speak to your foundation school administrators about it. You should also have a speaking up guardian and a guardian of safe working hours that are also there for you.
I worked in medical education for nearly 20 years and I strive to make this better for the junior doctors under my care and it breaks my heart to see that it still goes on especially as my son is now at medical school!

💐

Sorry to say with the exception of the racism sounds like every surgical job I’ve ever had !

Sounds the norm for F1 in surgery. As a nurse, on medical wards, I couldn't bear it when surgeons came to see a patient, so far up their own arses it was unbelievable. You'll survive, and hopefully treat your junior doctors with some respect in the future. Please report racist comments.

Life is too short and precious to stay in a job that is toxic and damaging to your mental health. No amount of money is worth being unhappy for. Your colleagues sound like a bunch of arse holes- I'd start looking elsewhere

YANBU and YABU.

Is this the only job you've had issues with? If so, then it's the post and there are shit posts everywhere. I assume you've fed back in the GMC survey - if it didn't occur in the timeframe you could, feed back to your clinical supervisor at the end of your attachment. Especially if you're not getting your breaks/lunch. The way you present the nursing staff behaviour is concerning as well - if the MDM isn't relating or communicating, this does lead to a toxic environment.

I will say there's a couple of red flags in your post about your attitude. You're not shit on everyone's shoes - though it may feel like that - but as the most junior member of the team, it IS your job to look up blood results and do the ward work. It IS your job to stop whatever you're doing and join them on clinical decision making ward rounds - this is a learning experience for you too. The consultants and registrars will decide what works best for the unit in terms of ward rounds - not you. As long as patients are seen and patients are safe (in theatre and on wards), that's the priority. The fact that you're seeing seniors so often is actually reassuring as it means you're well supervised.

You sound stressed but single attachments are a very short time in your career. If you are experiencing difficulties, especially if there's anything going on in your personal life - or related to the reasons you're 'out of sync', please speak to your ES. Hopefully, they'll be in a different specialty than you are now and can give you neutral feedback.

I used to be a ward sister. Medical hierarchy is toxic full stop and always has been. If you manage to hack it you will be so affected that you in turn will treat junior doctors like shit and so the cycle continues.

The answers? just to keep your head down, take deep breaths, find a colleague to just download too so you relieve some stress, remember how shit it was so you don't repeat the cycle.

"I will say there's a couple of red flags in your post about your attitude. You're not shit on everyone's shoes - though it may feel like that - but as the most junior member of the team, it IS your job to look up blood results and do the ward work. It IS your job to stop whatever you're doing and join them on clinical decision making ward rounds - this is a learning experience for you too. The consultants and registrars will decide what works best for the unit in terms of ward rounds - not you. As long as patients are seen and patients are safe (in theatre and on wards), that's the priority. The fact that you're seeing seniors so often is actually reassuring as it means you're well supervised."

I'm not saying ward work isn't my job. I'm saying prioritisation and efficiency is impossible when I'm constantly being told to attend catch ups or mini ward rounds. And that a core surgical trainee is perfectly capable of viewing an xray on a computer instead of asking me to take a photo and text it to them.

I have no issue with ward rounds. I do have an issue with being phoned when I'm in the middle of jobs my seniors have given me and told to abandon those jobs and come on another round, multiple times a day, and then asked why I haven't done xyz yet.

I've had other jobs and been told I was one of the most reliable and hardest working juniors they had. I always get picked by the registrars to round with them because they know whatever they give me will get done. My attitude sn't the issue. I have no problem with hard work.

Sorry to disappoint you but starting out in quite a lot of careers will mean starting at the bottom and not being looked up to by fellow colleagues. Words like 'subserviant' imply that you sound a bit disappointed that you're not getting the respect you think you deserve. Being a doctor is supposed to be a vocation, not a power-trip. You are not 'above' taking bloods.