New residents in the ER (wee rant)

[MassED, BSN, RN]

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.

[MassED, BSN, RN]

I am surprised there's no "bump" option on here!

[shoegalRN, RN]

Do you work where I work? LOL

I can certainly understand your concerns and it is very frustrating to work with that type of third year you are describing. I have had my share of "run ins" with a certain third year and when I feel like my concerns are not being addressed, I take it to the attending, in which I do have a good working rapport with.

I kept doing that to the point where the third year saw the attending really valued my input and then the third year started taking me more seriously. We are cordial to each other, may joke now and then, but we are by no means "tight like that".

I say just keep going to the attending if you have to. Sometimes our Chief Medical Director works in the ED as an attending and when this third year seen the rapport I have with him, I noticed things changed somewhat.

[canoehead, BSN, RN]

Our docs are very supportive, and talk about trusting their nurses to start labs, or titrate meds, and the baby docs follow their lead. IMO it takes a special kind of stupid to alienate someone with years of experience in a field where you're just starting. If they don't learn that from the other docs, my coworkers and I will usually be able to soften the edges given a week or so.

[MassED, BSN, RN]

Our docs are very supportive, and talk about trusting their nurses to start labs, or titrate meds, and the baby docs follow their lead. IMO it takes a special kind of stupid to alienate someone with years of experience in a field where you're just starting. If they don't learn that from the other docs, my coworkers and I will usually be able to soften the edges given a week or so.

"Special kind of stupid." Love love.

[Chesam7]

I have dealt with the same but the ones that usually have attitude are the new residents. It's like they try to make a statement and come off strong. They quickly learn that they need the nurse to save their butts. Example... I went to a resident to tell her she ordered atropine when I knew she meant to order Ativan. She yelled and told me her attending said to order that and why was I questioning her. I went right over to her attending and let him know. From then on she realized she should pay attention to nurses concerns. Try to approach the person in a private area and let them know how you feel. Sometimes they don't really see how they are acting until someone points it out

[ChristineN, BSN, RN]

I feel lucky after listening to you guys that the interns aren't even allowed to write orders where I work. The residents, while given more independence, are kept on a short lease.

[MassED, BSN, RN]

I have dealt with the same but the ones that usually have attitude are the new residents. It's like they try to make a statement and come off strong. They quickly learn that they need the nurse to save their butts. Example... I went to a resident to tell her she ordered atropine when I knew she meant to order Ativan. She yelled and told me her attending said to order that and why was I questioning her. I went right over to her attending and let him know. From then on she realized she should pay attention to nurses concerns. Try to approach the person in a private area and let them know how you feel. Sometimes they don't really see how they are acting until someone points it out

Wow, that is hilarious! Atropine rather than Ativan. Haa! I would imagine she was embarrassed!

This doctor is a THIRD (and final!) year! The other residents LOVE this person, by the way. They think this person is the best..... interesting.

[Rhi007]

I start on them when they're wet behind the ears...question everything and make them think. I've brought rmo's down a peg or two and registrars down right to the bottom of their perch...they need it, they need to know who knows most about their patient

[Esme12, ASN, BSN, RN]

I worked at one academic center and the residents were on a short leash...and were to listen to the seasoned RN's. I moved and went to another and it was the exact opposite...I quit and went to a busy non academic center because that air of superiority... it DROVE ME NUTS!

I am just too old to deal with that stuff....while I'm changing their diaper.

[MassED, BSN, RN]

I worked at one academic center and the residents were on a short leash...and were to listen to the seasoned RN's. I moved and went to another and it was the exact opposite...I quit and went to a busy non academic center because that air of superiority... it DROVE ME NUTS!

I am just too old to deal with that stuff....while I'm changing their diaper.

[shoegalRN, RN]

I have found that the residents with the worse attitudes are the weakest when it comes to their peers.

I have found that some of them use bad attitudes as a defense mechanism to cover up their insecurities when it comes to their medicine practice.

Some of our nurses in my ER has had to bring several of them down a couple of notches. They quickly realized the nurses can make or break their residency.