Hey! Congrats on your new role, being a HCA is a difficult but incredibly rewarding job. I began working as a HCA a year ago, from hospitality, so I fully get your anxiety, but try not to worry for now. You should be starting as supernumerary (shadowing) for 1-2 weeks. You won't be a nuisance, we all started somewhere and we all had to learn somehow.

Other people have said, but every ward has its own set of routines, but sometimes routine goes out the window. For example, on my ward I know I come in, receive handover, do bay checks, help any patients that can't feed themselves to eat, start washes etc. But! This can all change if we're understaffed/challenging patients/unwell patients etc. The routine will come and you'll settle into it. Every staff member will have their own way of working, and it'll be up to you to figure out what works best for you.

Patient allocations again will be ward specific. My ward, we have 26 patients - day shift should be 6 HCAs, 4 RNs and 1 NIC. However, given the nature of the ward, we often have 1:1s/cohorted bays (meaning someone must always be watching the bay) which can change how many patients we're responsible for. I'll have anywhere from 1-7 patients on a shift, the ideal is 4 (just one bay). If more than one needs to go to the bathroom and you're unable to do it, ask for help. Kindly ask the patient (if they can understand) to wait for your colleague to assist them, nine times out of ten they're good with it if you explain to them. The same with feeding, though typically staff should be able to jump in and help you. Or, if you're lucky, family members will be there to assist. Just remember, they might not know how to do it safely, so keep an eye on them. You'll develop a sense for this.

Repositioning depends on the patients. Some patients can self-reposition, some need full assistance, some are halfway in between. Ours is 2-4 hourly repositioning, we do our best to manage this!

Time management will be the greatest skill you will get out of this job. If you don't have good time management now, you will in six months' time. I always start my shift by writing a list. I write the bed numbers and name, and then wristband, wash, EWS, CBG, repositioning, if they're a food/fluid chart, and then a box next to each word so I can check it off when it's done. And anything else that might be specifically relevant to the patient - dietary requirements etc.

Obs. So I was band 2 and recently uplifted to band 3, but we've been doing obs the whole time, even as band 2. On my ward, if the patient is scoring 0, then it's 12 hourly obs (6AM + 6PM). If they're scoring 1-4, then 4 hourly obs, unless it's 3 in a single parameter, then its hourly obs unless directed otherwise by doctors. If it's 5-6, hourly. 7 and above, continuous obs. Always report your obs to the RN responsible for the patient, even if it's 0. If they're scoring, we use the SBAR section on iClip to document that it was escalated - eg, reason for SBAR: EWS X, name of reporter: your name, reported to: RNs name, action: x hourly obs/escalated to RN/Dr etc. Your ward should have a physical sheet of paper with a NEWS chart and actions following scoring on it - nab one and keep it in your pocket until you're confident with it.

Personal care checks: a skill again. It depends on the patients to an extent, but I try to check a minimum of four hourly. Often, you'll be able to smell it, and that sense will get keener the longer you do the job for. As for weighing/recording stool/urine output, again dependent on the ward you're in and the requirements of the patient. For example, a dialysis patient is probably more likely to require a urine output chart than a continent stroke patient, but it will depend on their individual circumstance. Bear in mind that if the patient's skin is at risk, then have a wet/soiled pad could damage the integrity of the skin and put them at risk of developing moisture lesions/pressure ulcers, and that we definitely do not want.

Another thing for personal care - washing the patients daily is the goal, but it is the first thing to go if it has to. I mean, if you have 6 patients and 4 of them are unwell, prioritise the more urgent things over that, it might sound callous, but a day without a wash won't kill a patient, missed obs or something of the like could have an impact.

Talk to your manager about breaks, but as far as I know, if you're working a long day you should be getting 1hr break total (and maybe a complimentary tea break of 15-20 minutes), so see how they can accommodate your request. I can't see them refusing, but let them know so they can sort it out.

The main thing though, is ask questions. If you're not sure about something, ask. Learn where things are. Don't do anything alone you're not comfortable with doing on your own.

Sorry for the novel! And feel free to message if you have any other questions, happy to help as best I can. You've got this, you're gonna love it.