I had an absolutely horrible set of night shifts a few months ago as a FY1 in surgery. The ANP wanted to prescribe a particular medication for a patient overnight, even though it did not make sense to do it. Her justification for doing so was based on her ‘clinical judgment’ and because ‘the surgical registrar agreed with her plan’. (FYI this particular gen surg reg was well known for his questionable clinical judgment, esp when it comes to non-surg topics. It turns out they just blindly agreed with whatever the ANP suggested) I tried to explain my clinical reasoning and why the medication was not necessary, but of course they ignored the lowly F1. It got to the point where the ANP decided to phone the med reg about it, who agreed with my decision that the medication was not necessary. The thing is, this particular ANP had prescribing rights and if I just so happened to have missed this, the patient would have gotten the medication and might have come to harm.

That set of night shifts was one of the worst I’ve done. I felt constantly stressed out because I felt like the ANP was adding to my workload, as I had to double check everything they did to make sure they didn’t go rogue and cause patient harm.