Dealing with MDs (residents)

diprifan · Aug 1, 2011

Does the Attending have any input? Do you guys give performance reviews of the Medical Staff? i.e. Fellows and Residents.

beeble · Aug 1, 2011

No, we don't get to give input. the attendings are nice, but not around on nights.

xtxrn, ASN, RN · Aug 1, 2011

Residents can be a pain. They're somewhere between scared to death and competent...some further along than others

With 'full' doctors (beyond residency), I've asked them who I need to call if they're not interested in helping. I've also called the nursing supervisor to cover MY butt when I can't get decent orders (from 'full' docs as well).

applewhitern, BSN, RN · Aug 1, 2011

That is odd. I have worked with lots of "residents" in my career and have never encountered one who was not interested in what you have to say. Or one who refused to help. Since you are responsible for your patient's care, just call your supervisor, charge nurse, or whoever your superior is, if you need help and can't get it. I find it strange that a resident would not/could not provide medical help when you need it. If it is simply nursing help that you need, that would be understandable. Have you tried to suggest to the residents just what you need or expect from them?

xtxrn, ASN, RN · Aug 1, 2011

That is odd. I have worked with lots of "residents" in my career and have never encountered one who was not interested in what you have to say. Or one who refused to help. Since you are responsible for your patient's care, just call your supervisor, charge nurse, or whoever your superior is, if you need help and can't get it. I find it strange that a resident would not/could not provide medical help when you need it. If it is simply nursing help that you need, that would be understandable. Have you tried to suggest to the residents just what you need or expect from them?

This is based on personal experience as a patient re: hard-headed residents (and the floor nurses would smile when I asked them about him). I was there for a 5 day video EEG (that's all that had been authorized by the Medicare advantage plan). For that, anticonvulsants are withdrawn at least partially if not completely to get the most complete exam. The resident (can't come up with a suitable, postable name for the j>*ka#$) would not change my meds. On Monday (1st day there) I didn't expect them to- so they could get baseline info. Tuesday, I expected my meds to be cut. Nothing. On Wednesday (only there for 5 days- need to get the lead out) I asked him why meds hadn't been cut. He told me he was interested in another neuro diagnosis I have....like I was there for his entertainment. Granted, dysautonomia isn't all that common- but I WASN'T THERE for that

I told his goofy butt to change the meds, or discharge me immediately. He got very defensive and said fine -- but he couldn't do ANYTHING without the attending signing off on it- so the attending shows up with Dr. Dips8*t, and I told him my concerns about not getting the test done I was there for- only half of the time left to get it done. The attending cut the meds. He had asked if I was willing to stay to get the test, and I told him absolutely- that's why I was there, and had arranged for my dog to be taken care of, and other arrangements- I didn't just take the bus up there for the h8ll of it.....

The idiot had to back off- but, he still kept talking about wanting to run tests for the dysautonomia, and I told him I'd been tested up one side and down the other years earlier and that's how I got the diagnosis (like maybe some doc had drawn it out of a hat--- sheeesh:uhoh3:). He was sure that with all of the weird stuff I have going on that there must be some syndrome that included most of them... WHATEVER !!! I had docs with years of experience diagnose me. He didn't impress me at all. There MAY have been something to what he was saying- but he went about it ALL wrong.

The nurses and EEG techs there were wonderful, and kept me informed about what was going on. Without them, I never would have known what the EEG was showing (nocturnal left temporal lobe epilepsy triggered when I start to doze off- not deep sleep...also kicks in if I get drowsy from blood sugar changes-- amazing how they can isolate things). I'd been there to see if I was a candidate to have part of my brain lopped off-- the locus of the seizures was in a place that was too tricky to mess with.

The nurses did NOT like this guy. Major teaching hospital in the upper midwest- a good facility....but they definitely got a jerk when this guy matched w/that hospital :)

That resident was a nightmare. When I asked him about things he got all "superior". When I told him he wasn't doing the one thing I was there for, he got angry. I hope his stethoscope rusts.

Altra, BSN, RN · Aug 1, 2011

I am very vocal, and will say something if I feel it isn't helpful, is negative, ect. I am not able to 'blow it off' as most of my coworkers are.
Between this, the understaffing, and the sometimes difficult patient population, I am burning out.
How can I help this situation?

1. Learn to pick your battles, and

2. Learn to separate whether or not a patient's problem has been dealt with ... vs. how you "feel" about a situation. There is a difference.

beeble · Aug 1, 2011

Well, I only talk to them re a patients issue. I dont bother them otherwise. They are part of an elite group and don't tend to socialize outside of that (sarcasm). it's when I don't get help with the issue, the issue is dismissed without discussion and/or the resident dosen't bother to treat me as part of the 'team' caring for the patient (but more of a waitress) that irks me.

ChristineN, BSN, RN · Aug 1, 2011

I worked at one particular hospital where alot of the residents seemed particularly dense about wanting to listen to the nurses. I would document, document, document, as well as page the seniors and/or attendings when ever necessary.

canesdukegirl, BSN, RN · Aug 1, 2011

Oh yes. I once had a first year resident write an order for MS04. I called to ask him to change the order, because the pt was allergic. This allergy was listed on the MAR, on the front of the chart, and on the H&P.

The resident didn't change the order. Instead he said, "Oh, it's unlikely that the pt has a TRUE allergy. She probably just gets nauseated or itchy or something. Go ahead and give it." Of course I refused, and he acted like it was SUCH an inconvenience for me to bother him with such a trifling thing like pt safety and all...so I went over his head directly to his chief, told her what was going on and she changed the order. I heard that the first year got quite the reaming from her.

Documentation and communication are your best friends when dealing with new docs that are stubborn for no reason. These types (thankfully, they are rare) will usually have their butts handed to them at some time by either their chief or the attending. Just make sure you cover your own turd cutter by documenting everything factually and in a timely manner.

Although it is very hard to deal with the "know-it-all" attitude from this population, know that they are learning, and but sooner or later, they will recognize that our input as nurses IS valuable. The ones that don't listen to other members of the multi-disciplinary team are also the ones that the rest of their peers can't stand.

Altra, BSN, RN · Aug 1, 2011

Well, I only talk to them re a patients issue. I dont bother them otherwise. They are part of an elite group and don't tend to socialize outside of that (sarcasm).

Does intransigence go both ways?

xtxrn, ASN, RN · Aug 1, 2011

Does intransigence go both ways?

For those who also use the word "uncompromising", and not the $20 words:D

http://www.merriam-webster.com/dictionary/intransigence