You are the medical registrar on a night shift where two of the four SHOs are absent and no locum has been found. How do you manage the shift, and what do you do afterwards?

Question

It is 21:00 on a Saturday. You have one SHO and one foundation doctor covering the medical take and 260 inpatients. The site manager tells you no locum cover is available.

Accepted Answer

My first job is to make tonight as safe as it can be, and that starts with accepting that three doctors cannot do the work of five. So I would decide explicitly what will not be done — routine cannulation, non-urgent ward reviews, discharge summaries, non-essential jobs — and tell the nurse in charge and the site manager what we will and will not be covering, so expectations match reality rather than everyone assuming their bleep will be answered. I would allocate work by task and acuity rather than by geography: sickest patients and time-critical tasks first, with the foundation doctor paired on tasks within their competence and the SHO taking protocolised time-critical work. I would tell both of them clearly to bleep me early and often, and I would keep a live list rather than relying on memory. I would escalate at the time, not afterwards — the on-call consultant and the site manager both need to know before something goes wrong, and I would make a specific ask: a consultant coming in, a specialty registrar helping with the take, or critical care outreach reviewing the deteriorating patients. I would ask nursing colleagues what they can safely take on. I would document the staffing position in the notes of patients whose care was affected, factually, and record the decisions I made because of it. Regardless of whether anyone comes to harm, I would Datix the shift as a patient-safety concern, because a rota gap only becomes a board-level problem when it is documented, and the corridor of unreported unsafe nights is how these persist. Afterwards I would exception report, raise it with the guardian of safe working hours and the rota lead, and if it is recurrent take it to my educational supervisor and the trainee committee. Finally I would make sure everyone got a break and a debrief, and acknowledge to them that the shift was not a reflection of their performance.

Persistent Rota Gaps and an Unsafe Night Shift

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