New residents in the ER (wee rant)

[MassED]

Ok, so perhaps this might be more than a wee rant...

Every July we have new ER residents, interns. It is a busy time in the summer and to have new residents coming in can be challenging, depending on how they adapt. It slows down times for disposition, as naturally they are learning and even though nurses know that this CP will have labs, IV, EKG, CXR, we have to wait for the new interns to order these. Sometimes the orders trickle in and everyone gets a bit exasperated. Sometimes the issue is not the new residents...

Sometimes it's the new third years who are high on their supposed power and control, now being the top dogs in the department. There is one who consistently talks over the attendings, ignores experienced nurses concerns regarding patients, disregards patients and is slower than a snail to boot. It is expected when a resident is new that things will take time, but the dis-respect with this person's attending and subsequent dis-respect with nurses is so frustrating. I realize we cannot change a zebra's stripes, but to know this person is in their last year and some of these issues are more prominent than ever, what is one to do?

I definitely don't want to put my neck out there to complain to their superior, as that rarely does anything but to put YOU on the radar. I know how that goes. Doctor's will look out for one another to a fault. I have seen it repeatedly. When I speak to this person about disposition of admitted patients and concerns I may have, this person actually has WALKED away from me without any acknowledgement of my concern/s. I ensure that I am tactful, respectful, and professional in my interactions, because I want the same in return. The thing is, I see this person can be professional and even nice to other nurses, so I am unsure on how to reconcile this. Other people have noticed this, as well, so I just move on and ignore this and go above to the attending for what I need for a patient. I view this person as quite arrogant and condescending, but I am puzzled as to why it is directed at some, but not at others. I know these traits are usually a cover up for their own insecurities, so I remember that in the back of my mind when I'm interacting with said person, but it gets pretty tiring. Our work environment demands so much energy and attention that I have little patience for drama or a person's own baggage.

I have been doing this a while and have great relationships with all but a few people in my environment. There are a few bad apples out there, and I certainly do not need to have great rapport with everyone, as I can do my job well with just mutual respect with coworkers. Really, we are not at work to make friends. It is work. Does it make life easier to get along well with others? Well, of course it does, but life isn't always how we want it to be. I prefer to have moments of laughter, because face it, we all need it. We work 12+ hours with each other and I strive to have great working relationships with my coworkers, including housekeeping, xray, registration, etc. Any and all are important in the flow of my day/night.

The issue is, how do you deal with those that prefer not to see you as a professional? For whatever their hangups are, how do you handle these types of people? My best coping mechanism is to treat them like I do any other person and if I don't get the intended response for patient care, I move over their head without apology. Period.

I made this comment when I was precepting the other day about procedural sedation and said "make sure you have the consent, that you physically see it." I made the comment (I am laughing now) that even though it is said they have it, you still need to see it, as it's our job to ensure since we're documenting that we have consent. I understand verbally there's consent, but documentation is key. I am not distrusting, I just know from prior experience that you verify, verify, verify. As it turned out, they did not have consent, because one doc assumed the other doc had obtained it, when neither had not... so that reinforced my habit of checking.

[Rhi007]

One of the docs I had was very detached from both patients and nursing staff, House officer, bit unsure, got stuck with me....I had him baking cookies and cakes for the nursing staff in 3wks and all it was, was a barrier that needed to be broken down to allow people to see the real him. Using chocolate, lollies, laughter/jokes and a simple good morning or hello and he softened

[Pudnluv, ASN, RN]

Where I work, med students have to do a couple of nursing shifts, where they buddy with a nurse and follow us around to see how we do things. They do this prior to beginning their medical rotation. This is a way for future docs to really see how and what we do. Many are surprised, not at just how we work, but at how much knowledge we have.

I have to say that most of our residents are very respectful to the nurses and the attendings, certainly back us up. Occasionally we get an arrogant resident who seems to think that because we are only "nurses" we can't possibly know what we are talking about. My way of letting them know that their behavior is unacceptable is to remind them that I have been doing this for 20 years, long before they even knew what they wanted to be when they grew up. I also remind them that my job is not only to follow their orders, but to make sure their orders aren't going to kill anyone. We are lucky, that the attendings also recognize the arrogance of these residents and help to put them in their place.

[gcupid]

How do you all deal with extreme frustration with a resident? It appears that any suggestions I offer or requests for orders are ignored only to be implemented later after the crap hits the fan....

The attendings attitude towards this resident is to allow for sink or swim in which he always sinks. The attendings only become involved just right before a patient crashes. He should be further along and I believe they don't know what other method to do in order for this resident to succeed.

[MassED, BSN, RN]

How do you all deal with extreme frustration with a resident? It appears that any suggestions I offer or requests for orders are ignored only to be implemented later after the crap hits the fan....

The attendings attitude towards this resident is to allow for sink or swim in which he always sinks. The attendings only become involved just right before a patient crashes. He should be further along and I believe they don't know what other method to do in order for this resident to succeed.

There are a few older attendings who are like this and it drives me crazy. They should be teaching, not letting less experienced residents handle a code or intubation without proper instruction. Let's face it, we, as nurses end up assisting these poor residents. It is not what is best for the patient, so often I am bull-headed about getting an attending for a critical patient. The residents need to see their leadership and guidance. Some need it more than others. I feel like the longer you are in this, the more you have to speak up to be heard. Some might confuse this for something else, but when it is for patient safety, I will address what I need to, even if the doctors don't like it. I cover my butt, and make sure the patient is taken care of first and foremost. I tend to get miffed when a doctor doesn't take what I'm saying seriously. I had one tell me the other day after I thanked him for his quick response to the trauma room, he said "you only call when you need me." Ahh! Nice! I believe this too, so it was nice to have that affirmation.

Stick to your guns and go after those attendings for accountability! Those residents will thank you too.