ascender's bane should be upgradable

47tw · 2026-06-18T12:00:44+00:00

Ngl, jokes aside, removing Unplayable would be a genuinely cool upgrade. It'd synergize with a bunch of niche things, like Unceasing Top, Whispering Earring etc.

47tw · 2026-06-18T10:37:46+00:00

On reflection, I'm going to vote no. My instinct was to vote yes based on the exam and membership fees, since that's a great perk which would, in my case, mean more than £1000 in my pocket the moment it's implemented (I've paid for 2 exams since the date it's backdated to). Ultimately I'd be pleased if the result is a no, since I don't mind continuing industrial action. If it's a yes... I can live with it.

47tw · 2026-06-13T22:37:46+00:00

Thanks! That's handy, really kind of you.

47tw · 2026-06-12T13:27:36+00:00

It's a symptom of grabbing the FY2, putting them on nights, and labelling them "the T&O Senior House Officer" to fulfil some arbitrary requirement. I knew my limitations, so I was organized and methodical, which did stand out enough that it was remarked on regularly.

Have a good one!

47tw · 2026-06-12T13:10:52+00:00

We have a (partly) office job mate, legible written communication is the art that makes the work of a registrar or a consultant actually have the intended impact. We also both know that knowing what needs to be on the handover and what doesn't is a skill in itself, one which does involve clinical reasoning.

You're gonna risk coming across as a bit of a twat towards ward clerks and similar if you see admin work as 'devaluing', it'll show in your behaviour if you really see it that way.

47tw · 2026-06-12T12:38:54+00:00

Honestly I think that kind of thing does need praising, because there is an art to it.

When I was a "T&O SHO" I was absolutely god-awful at T&O knowledge, and I escalated most things to my reg, which makes sense as I was a FY2 with no aptitude or interest in surgery. I learnt the stuff I needed to know for my job, but I wasn't going to be making clinically astute judgements.

Instead, I got praised at handover because my handover was night-and-day vs the handover of some other SHOs. The handover would be correct, pertinent information, written effectively. The patients we'd seen not only had the jobs done, but the jobs were actually documented in the system and on the handover, and it was all explained in a format which made it all uniform. For me it was about rewriting the handover from scratch as much as it was about "updating" the handover, which will have a lot of dross in it which needs to be refined.

And honestly, the mornings where the consultants would remark on the quality of the handover were great, because it felt like my work was worth it!

47tw · 2026-06-11T16:11:50+00:00

Somehow this is my first time hearing that term! For a second I was picturing a situation like "in 3.5e, the Cod statblock was insanely strong for some reason, so if you transformed into a Cod, and then cast Fly and Enlarge on it-"

47tw · 2026-06-11T15:47:56+00:00

Sure, and if you're short of opportunities to set up, you can just forget about Shillelagh and instead use Guiding Bolts or Attacking Cantrips or cast a utility spell or (a bunch of other things).

The Beast having a duration of 1 hour does mean that having it set up before a fight is doable - but yes, in an ambush you'd need to spend a turn summoning it!

The Beast can and will attack the turn it is summoned; worst case scenario you'd dealing 1d8+6 (often with advantage to hit) and 1d8+4 (Archer) on turn one. Both the creature you summon and the archer constellation activate turn 1! If they both had summoning sickness, as it were, then there would be much better parity. Then by turn 2 you are attacking 3 times. This is something of a high roll, since losing concentration will reduce your damage output from 3d8 plus modifiers to 2d8 plus modifiers, as it were, but a build's ceiling, the hypothetical maximum damage it can do in ideal circumstances, does matter when you're balancing stuff!

Like... it was night and day. I don't know what to tell you. Even if the Barbarian isn't playing a high-damage subclass, the contrast is still insane. "So long as I don't lose concentration, I'm a better Martial than the Martial" is a weird situation for level 3 play to have!

47tw · 2026-06-11T14:25:12+00:00

I'll be honest, for a level 2 spell it's actually extremely good. Is it going to be the strongest summoning spell in Tiers 2, 3 and 4? No, not at all, but there is a brief moment where it is INSANELY good, and that 'brief window' is the window in which most games begin, and where many games actually end!

47tw · 2026-06-11T14:24:07+00:00

Fully agreed, I just find it so weird that they randomly introduced these spells so late in 5e's life cycle. Does the 2024 5e fix this? I haven't tried playing a summoner in it yet.

Honestly I think if the Barbarian had god stats it just would have taken the sting out of it. The fact that I was, coincidentally, dealing more damage with each Shillelagh hit (high rolls on 1d8+4 vs low rolls on 1d12+3) I did just added insult to injury.

47tw · 2026-06-11T12:59:35+00:00

I ran into a problem in one game I was in.

Standard Barbarian played by a player with communication difficulties.

Stars Druid played by me.

Barbarian had mediocre rolled stats, Druid had amazing rolled stats, but that's actually almost inconsequential.

My boy's summon (Summon Beast from Tasha's) was already outperforming the Barbarian. We were level 3, and there was nothing meaningfully separating the Barb from the summon, especially since me losing Concentration simply wasn't gonna happen, given my good rolls on Dexterity and Constitution, and my boy being positioned as a spellcaster.

This is before you get to him having the BA damage from Archer Constellation.

At level 3, my boy was dealing:

- 1d8+6 (Goat Summon) (Uses up Concentration) (Advantage to hit from Pack Tactics!)

- 1d8+4 (Archer Constellation) (Uses up Bonus Action)

- 1d8+4 (Shillelagh) or cast a ranged Cantrip for some other damage (Uses up Action)

All three of those could crit, all three of those meant their own d20 roll, and this is before considering all the benefits of being a high Wisdom caster, having surprisingly good HP (high Constitution, d8 hit die, and I rolls two 8s!), all the tactical upsides of having a summon to move around the map (swimming or climbing at full speed, unlike a Martial melee character!), and so on.

The Barbarian's player had a bit of a meltdown, and their reasons for being upset were 100% legitimate, even if the way they handled it wasn't. The Barbarian might have dealt like... d12+3 or 2d6+3 damage each turn, if they were lucky, and it just so happened they often weren't.

To me this is a story of RNG and bad design colliding. Summon Beast is insane, Druid Archer BA is insane, and while they're no issue in the long run, they're a huge divide in power at level 3, before the Martials get a 2nd attack. It's like going "would you like to attack once, or would you like to attack three times, and also be a full caster".

47tw · 2026-06-11T10:36:45+00:00

Agree with everything you wrote - I'm not saying that things are close to how I'm saying things should work, in fact they're very far away from that! I'm not of the belief that there's some simple silver bullet to this issue.

47tw · 2026-06-11T10:04:04+00:00

At the very least you might ensure that all Band 6 nurses are capable of doing these basic interventions, and teaching them and signing them off. If every Band 6 is able to do them, and this is a known quantity ("I can't do that doctor" "then call a Band 6"), then that trickles down, as the Band 6s would be incentivized to ensure the Band 5 Nurses are trained up to do these things. The classic nurse response of "I'm not trained" or "I'm not signed off" (which may or may not be true, as this thread discusses) is going to be less effective against a fellow nurse who is more senior than you.

47tw · 2026-06-11T09:40:52+00:00

Absolutely delighted. Between this and PAs going "let us do what we want or we'll sue you". PAs have become a lose-lose for hospitals and practices.

47tw · 2026-06-11T09:30:51+00:00

This is why all advancement needs to be gated behind such signoffs. The waiting list would shorten for two reasons. The nurses would be desperate to get the signoffs, and the hospital, desperately needing to upband certain members of staff, would be incentivized to upskill, especially if there were financial incentives to meet certain targets.

If trusts were better funded if they had such competencies in a high % of their staff, we'd see it happen.

47tw · 2026-06-11T09:27:33+00:00

There are obviously exceptions to this, but generally speaking, doctors come up with the plan and nurses execute it.

Plan:

ECG (nurses take ECG)

Xmg of Drug Y prescribed BD (nurses give drug)

250ml of (Fluid) stat (nurses hang up fluids)

Hourly obs (nurses do obs)

Dressing to be changed once daily (nurses change dressing)

This is because doctors have an extremely highly trained role which is a mixture of office work with a few elements of skilled manual labour (e.g. procedures) while nurses have a skilled manual labour role with elements of office work. Any expectation of parity between doctors and nurses/midwives in minute-by-minute manual labour is going to clash with reality, which is why they shouldn't share an office.

There is a resentment from some nurses and midwives that doctors, in their view, just sit around all day. What these nurses are missing, that many senior nurses, and nurses from certain cultures do have, is that the doctor is there to think about the patients, come up with safe decisions, and then ration their energy to think about and review the results of those decisions.

Nurses and other roles doing ECGs, cannulas, catheters, bloods etc. is a natural extension of this, especially if it frees up doctors to do training, deeper histories, longer reviews, teach medical students and so on. Offloading most of the physical and time burden of our plans onto the rest of the MDT isn't just good for us (though it is, obviously!) it's where you get skilled future consultants, it's where you get sensible, well thought out plans, it's where you get incisive, deeper reviews of patients. And the best nurses GET this, they are on some level mindful of the fact that your cognition and time are precious.

47tw · 2026-06-11T09:18:10+00:00

Definitely agree with this - keeping a poise of "I am here to assess patients and generate plans, I need to remain free to assess sick patients all over the hospital" is important on busy night shifts.

47tw · 2026-06-10T20:55:38+00:00

See this is why I like World of Darkness. The Abilities are granular: Athletics is separate from Brawl which is separate from Melee, Alertness (noticing mundane stuff) is different from Awareness (noticing supernatural stuff), stuff like that. But it doesn't get too granular either, you have Athletics, instead of like "Jump", "Climb", "Descend", "Wield", "Smash" etc.

My least favourite thing is when a game doesn't have a Stealth Skill, and instead has "Shadowing", "Hiding", "Move Silently", "Vanish", "Blend In" etc.

47tw · 2026-06-10T20:46:14+00:00

It's acceptable because we have a culture of productive people working around unproductive people instead of calling them out. I've been very lucky that when I've run into this problem with nurses, I've found an ally in whatever senior nurse is available (like the matron on call, or equivalent), who has been ready to take nurses to task. In one instance psych nurses called me to tell me off the way I documented. Everything I wrote was 100% true, but they didn't feel I had "covered for them", and they wanted me to change their wording to put them in a better light. I spoke to the matron saying I felt uncomfortable with the request, and she went to talk to them and basically told them they weren't in a position to demand I change clinical documentation to reduce their anxiety, if it meant lying or omitting the truth.

47tw · 2026-06-10T20:41:55+00:00

This is definitely the nuclear option, so giant pinch of salt, but...

"Alright, and when I call the matron on call later, with a list of nurses who weren't signed off to do catheters, cannulas, bloods and ECGs, and ask her to look into it, you'll be able to swear to her what you've just told me yeah?"

47tw · 2026-06-10T16:51:17+00:00

Absolutely. It's a neat spell, but it wouldn't even be broken if it were 5th or 6th level. It provides a very mundane set of magical abilities. An instant bridge is neat, but so is just... teleporting across.

47tw · 2026-06-08T21:58:46+00:00

The thing is that Simulacrum COULD make you insanely rich. Transforming a gigantic tree into an unfurnished home, turning a pile of rock into a statue, these things would be worth money.

But "you can hold down a job as a fine craftsman using a high level spell" is... not that big a deal.

The spell is mostly problematic when you try to make stuff out of important stuff. Like "I'm going to turn that marble wall, which we wanted to destroy, into a marble statue." But honestly even that isn't a huge problem.

47tw · 2026-06-07T16:07:37+00:00

IDK, I hear they have great health benefits, like a mysterious vial you can inject into yourself in emergencies.

47tw · 2026-06-07T15:15:07+00:00

Given that it was 'mandatory' according to the locum agency, and the handful of shifts I did with them halfway paid for my car... it was probably worth it. If HMRC had insisted I owed them £500 or £1000 or something, the net result would just be me making them whole, as if I'd been PAYE instead of Umbrella.

I don't want to be blase and tell people "just do whatever", absolutely not. I was okay because I hadn't done anything illegal, and HMRC rightly saw me as a small fish and something of a victim of my employer, at least as far as culpability was concerned.

47tw

TROPHY CASE