Teaching at a teaching hospital

[313RN, BSN, RN]

I work in a large teaching hospital with new residents on the medicine service rotating through every month. The fellows also rotate, but they are a consistant group and all pretty good.

My question is about how much teaching/coaching I can get away with doing for the residents and the best way to go about it.

I'm not talking about teaching them medicine, I'm underqualified to do that.

I want to help develop them as leaders and in some cases, as people. I tend to believe that residents who learn to trust themsleves, trust their nurses and learn a thing or two about being effective leaders will one day be attendings who are willing to talk with staff, train more good residents and do their job without having tantrums like spoiled two year olds.

If we're in private (like doing a bedside procedure with a sedated or comatose patient and the situation allows for it) I'll let them talk with me about their frustrations and try to gently help them find ways to deal with them.

Other times I'll joke with them and a little and see how they respond. Like asking a couple of med students to help me clean up a code brown. When they both stood up to help I let them off the hook, and told them and the fellow a day or so later that I was pleased with their willingness to help.

When I asked a resident last week if he'd like to "step up" and help out since our PCA/CNA/Aide got pulled and he said "you mean step down" I had an opportunity to coach him a little about what being a leader means.

But sometimes you have larger situations where they could use some help. Like the Anesthesia resident who panicied in a code, called an attending and claims he was told to call an overhead code- something NEVER done in the ICU setting at our hospital. Or the resident who froze when we needed to start pressors. Or the one whose patient went into SVT (and was known to respond only to electrical cardioversion) left the floor to get a fellow as we were pulling out the crash cart.

Is there a good way to approach someone like this after the fact (a day or two later after everyone has calmed down) and help them think about other ways they could have handeld the situation? Or is it better left to them to figure it out, or hope that the fellow talks with them one on one?

What do you think?

[brownbook]

You sound like a good nurse with a lot of knowledge and confidence.

I think each incident has to be handled individually, there is not a one size fits all answer.

If you have a friendly relationship with a resident who panics, mishandles a situation, you could bring it up when things calm down. You would have to have the insight to tell if they seem reluctant to talk or were relieved that you brought it up????

I would leave bigger issues, or if they didn't seem to want to talk, up to their peers or instructors.

[Guest717236]

Good question. Years ago at a major teaching hospital required

medical studentsto shadow a nurse for a few days in the specialty they were assigned.

The medical students found it very helpful as they saw glimpses of the nurses day prior.

To follow the nurse throughout the day was enlightening and helped

strengthen the relationship between the MDs and the RNs. They often remarked

they had no clue of the intensity of a nurses working day.

You might want to float an idea to the nursing department on this, and

if medical school is open to the idea have a similar program.

For residents, not sure if their time frame would allow, but maybe a nurse

resource person (like you!) to consult with.

We had a great working relationship with our interns/residents and

often nurses were consulted for various issues.

Here is a similar program

http://dartmed.dartmouth.edu/summer05/html/vs_mantra.php

[canesdukegirl, BSN, RN]

If you were in front of me right now, I would give you a high five/fist bump/complicated hand shake or a big fat hug! You are the kind of nurse that I love to work with. Helping residents become confident in their abilities has a ripple effect and will only lead to positive outcomes for them, the patients, the nurses and everyone else that encounters that resident. Many older attendings have stories of when they were brand new residents and say, "I will never forget this nurse who helped me when...". They remember, and they are grateful.

When you have a skittish resident during a code, get their attention, hold their gaze and tell them to just follow what you do. If at all possible, explain everything that you are doing while you are doing it. Let them observe first hand and then they will be more confident about running the next code. This will be an invaluable experience for them. When the code is over, take out the algorithm for ACLS and review the steps that you followed. It will make more sense to them when they have seen a code, and then can read about rationales.

I would not pull them aside to talk about what happened. They have no doubt beaten themselves up about it already. More than likely, they left the code feeling inadequate, like a failure, and questioning whether or not they could ever make it as a doctor. I have seen this happen a few times in my career with residents who have frozen during their first code. They will be embarrassed to talk to you...but when the time is right, they may joke around with you about it later. Just wink at them and reassure them that you will help them out again when another situation comes about.