If you learn only one non-clinical skill for on-call, make it this:

Work well with nurses.

They are not just “calling you for jobs”.

They are:

your early warning system
your extra eyes
your patient safety net
and often your best source of clinical information

The best on-call doctors don’t work alone.

They work as a team.

First mindset shift

Stop thinking:

❌ “Nurses keep bleeping me”

Start thinking:

✅ “Nurses protect me from missing sick patients”

Most serious deterioration is spotted by nurses first.

Not doctors.

If a nurse is worried, you should be worried.

Always.

Step 1 — Introduce yourself early

At the start of your shift, quickly go to each ward:

Say:

“Hi, I’m the on-call SHO/Reg tonight — please bleep me if you’re worried about anyone.”

This takes 30 seconds.

But it changes everything.

Why?

Because:

they know your name
they feel comfortable escalating
communication becomes easier
fewer delays

Unknown doctor = delayed escalation
Friendly doctor = early escalation

Early = safer.

Step 2 — Always ask nurses who they’re worried about

This is one of the highest-yield habits you can develop.

Ask:

“Anyone you’re concerned about tonight?”

Not:

“Any jobs?”

Big difference.

They’ll often say:

“Bed 5 looks worse”
“BP trending down”
“More confused today”
“I don’t like how they look”

These are gold warnings.

Often before NEWS even rises.

Experienced nurses’ instincts are incredibly accurate.

Trust them.

Step 3 — Take concerns seriously (even if obs look OK)

Classic mistake:

Obs normal → doctor dismisses concern

But many deteriorations start with:

subtle confusion
“not themselves”
reduced appetite
just “looking unwell”

Nurses notice these first.

If a nurse says:

“I’m worried”

Go see the patient.

Even if it feels minor.

Better one unnecessary review than one missed arrest.

Step 4 — Communicate clearly and respectfully

How you speak matters.

Avoid:

❌ “That’s not urgent”
❌ “I’m busy”
❌ “It’s fine”

Instead say:

✔ “I’m with a sick patient — I’ll come after”
✔ “Call me if they worsen”
✔ “Thanks for flagging”

Small wording changes build trust.

And trust means:
👉 better escalation later.

Step 5 — Ask for information before walking

When bleeped, don’t just walk blindly.

Ask:

What are the obs?
NEWS score?
What’s changed?
How urgent?
What exactly do you need?

This helps you prioritise properly.

It also shows you respect their time too.

Teamwork, not firefighting.

Step 6 — Use nurses’ experience

Many nurses have:

10–20 years ward experience
seen hundreds of deteriorations
excellent practical knowledge

They often know:

which patient always drops BP overnight
who doesn’t tolerate fluids
who pulls lines out
what usually works

Ask them:

“What happened last time?”

You’ll save time and mistakes.

Step 7 — Close the loop

After reviewing a patient, update them.

Don’t just disappear.

Say:

“I’ve started antibiotics — please repeat obs in 30 mins and bleep if worse.”

Clear plans reduce repeat bleeps and confusion.

And nurses feel supported.

Step 8 — Help when you can

If you’re already there and it takes 30 seconds:

adjust oxygen
prescribe analgesia
fix chart
write quick order

Don’t create unnecessary back-and-forth.

Small helpful actions build huge goodwill.

Goodwill = smoother nights.

What NOT to do

Common junior mistakes:

❌ being defensive
❌ ignoring “soft” concerns
❌ talking down to staff
❌ disappearing without updating
❌ blaming nurses for calling
❌ acting like tasks are “beneath you”

This damages trust quickly.

And suddenly every bleep becomes stressful.

Real NHS truth (important)

Doctors rotate every few months.

Nurses stay for years.

They know:

the ward
the systems
the patients
what usually goes wrong

Use that knowledge.

You’re not expected to know everything.

You’re expected to work safely.

The senior doctor secret

Calm registrars don’t get fewer bleeps.

They just:

communicate clearly
build good relationships
get earlier warnings
prevent crises

Which makes the shift feel easier.

That’s teamwork, not luck.

Simple habits to remember

At the start of every shift:

✅ Introduce yourself
✅ Ask who worries them
✅ Take concerns seriously
✅ Communicate plans clearly
✅ Be respectful and approachable

Do this consistently and nurses will actively help you.

Your shift becomes 10x smoother.

Take-home concept

Nurses are not interruptions.

They are your early warning system.

If you work with them well, you’ll catch deterioration early and feel in control.

If you don’t, you’ll spend the night firefighting.

Good on-call medicine is team medicine.

Always.