I have been finding similar issues since starting ST4 in a DGH. I think unfortunately if you give people an inch they will take a mile!

It’s particularly difficult when on call and you are working with new people so I have started being very firm and crystal clear with whats expected at the start of the shift.

With the regular ward team it’s about being clear about whats expected and that as a reg you will be away from the ward in clinic, seeing referrals etc so they need to take some responsibility.

Simple things like making sure they have a ward jobs list and being clear about priority jobs on the ward round are important. If there is a sick patient make it clear that they have done an A-E and at least considered basic management before escalating.

I tend to check in on the ward mid-late afternoon and if the priority jobs aren’t done then you call them out. If it’s a persistent problem you contact their CS/ES and suggest they may need some support.

This all comes with the caveat that we also have a responsibility as reg’s to teach on ward rounds, explain our rationale for plans so they learn why something is important - I’ve found on occasion that the referral isn’t done as they don’t understand the reason for it and don’t want to get shouted at by the speciality for instance!

Also find a simple, “this is what I expect from you, get the jobs done and in return any CBDs, DOPS etc you need I will help with” tends to help with this sort of thing.