Dealing with MDs (residents)

[beeble]

Hi, I would like help with this subject. For the most part, I don't have problems with residents. But there have been instances when I felt my concerns were not listened to, or when I needed their help and didn't get it. We have (as is everywhere it seems) an understaffed unit with the underserved population (and the whole host of issues that brings with it).

I think this issue has come up mostly with first year residents, it seems. 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?

[Merlyn]

Just remember this" God made residents because he was disappointed with the apes." I had one that played around with a body when the family was outside the room. One that was more interested in hind quarters of the female staff then he was with a dying patient.

Some of them are good and some are morons. That's life in the big city. Do the best you can with the good ones and put the bad ones back in their cages.

[xtxrn, ASN, RN]

Just remember this" God made residents because he was disappointed with the apes." I had one that played around with a body when the family was outside the room. One that was more interested in hind quarters of the female staff then he was with a dying patient.

Some of them are good and some are morons. That's life in the big city. Do the best you can with the good ones and put the bad ones back in their cages.

:rotfl::hpygrp:

[CCL RN, RN]

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

Oh yes they are around on nights. They are always accessible. Just chose this option carefully.

[xtxrn, ASN, RN]

Oh yes they are around on nights. They are always accessible. Just chose this option carefully.

Attendings or residents?

[wtbcrna, MSN, DNP, CRNA]

I think a lot of the problems between nurses and physicians is communication. We are taught so differently that it is often as if we speak two different languages. Also, there are a lot of residents that have done nothing but goto school, they have never held down a real job, and they have no professional communication skills gained from working as an adult.

I think as nurses we are also to blame at times. There are many nurses that cannot/will not look at the medical reasoning behind an order they just hide behind their unit's regulations without seeing what is best for the patient.

There should be a book learn how to speak physician for nurses, and a book learn how to speak nurse for physicians...

There are also some people who are just jerks, and nothing you do is going to change it.

[ZippyGBR, BSN, RN]

from the Outsider (rightpondian) view this is a symptom of the power politics in play in US healthcare where Medical staff are seen seen as 'earners' and everyone else is a 'cost'

In the Uk it's widely accepted that how a junior interacts with the Nursing the staff can make or break them , and the Consultants are always interested in decent feedback on how their juniors are doing - because no one wants to be the person who gives the jerk a good report, interaction with the team is also incorporated into the assessments of juniors and Higher specialist trainees by have '360 degree assessments' as part of the training programme where a variety of professions are asked to comment on the Doctor's progress and abilities - if they are doing well their supervisor will let them give out the forms, if there are issues the supervisor gives out the forms !

It's also clear in the UK that medical Staff cannot directly influence the Disciplining of other staff groups - well in fact no one can 'write someone up' apart from their 'chain of command' - anyone can express a concern to the chain of command and/or submit an incident form ...

Another thing to remember is that a patient is admitted to the hospital as the patient of a Consultant / Attending - s/he is ultimately responsible for the medical management of the patient - not the juniors.

[xtxrn, ASN, RN]

from the Outsider (rightpondian) view this is a symptom of the power politics in play in US healthcare where Medical staff are seen seen as 'earners' and everyone else is a 'cost'

In the Uk it's widely accepted that how a junior interacts with the Nursing the staff can make or break them , and the Consultants are always interested in decent feedback on how their juniors are doing - because no one wants to be the person who gives the jerk a good report, interaction with the team is also incorporated into the assessments of juniors and Higher specialist trainees by have '360 degree assessments' as part of the training programme where a variety of professions are asked to comment on the Doctor's progress and abilities - if they are doing well their supervisor will let them give out the forms, if there are issues the supervisor gives out the forms !

It's also clear in the UK that medical Staff cannot directly influence the Disciplining of other staff groups - well in fact no one can 'write someone up' apart from their 'chain of command' - anyone can express a concern to the chain of command and/or submit an incident form ...

Another thing to remember is that a patient is admitted to the hospital as the patient of a Consultant / Attending - s/he is ultimately responsible for the medical management of the patient - not the juniors.

Actually, more and more MDs are employees of a hospital and their healthcare system, and NOT private practitioners anymore... they get a salary- not direct reimbursement from insurance, Medicare, or Medicaid

When an MD did a painful stim skin twist on me that left severe bruising, an incident report was done, and the hospital was very quick to mail me a letter saying he was acting on his own, and not according to the policies of their institution- threw him under the bus in short order. He was not representing them well in what he did; most MDs in the city I'm in are affiliated with a hospital- a FEW have privileges at more than one, but most require a patient to go to a specific hospital in order to have them continue them to be their MD.

[CCL RN, RN]

Attendings or residents?

Attendings. They have a pager. If your resident is being a jerk, and it interferes with the safety if the pt, give them a call. If you need to speak to them and it can wait, page them at 6a.

[xtxrn, ASN, RN]

Attendings. They have a pager. If your resident is being a jerk, and it interferes with the safety if the pt, give them a call. If you need to speak to them and it can wait, page them at 6a.

I don't need to speak to them at all Just clarifying who was supposed to be available-- when I posted that, I actually had a question in mind- evidently it wasn't enough to remember now! :) I'm used to docs taking call for their own patients (from where I worked in TX)- and rotating in their own groups. When I came back to an IL city that thinks it's a real place, I got used to the hospitalists, (peds), but other docs admitted to their own service there as well... In 19 years I worked as an RN, I've disturbed many docs at all hours- :) In the 7 years on disability, I"ve dealt with more hospitalists and residents- the hospitalists were good. The resident I dealt with as a patient was a .........

[CCL RN, RN]

I don't need to speak to them at all Just clarifying who was supposed to be available-- when I posted that, I actually had a question in mind- evidently it wasn't enough to remember now! :) I'm used to docs taking call for their own patients (from where I worked in TX)- and rotating in their own groups. When I came back to an IL city that thinks it's a real place, I got used to the hospitalists, (peds), but other docs admitted to their own service there as well... In 19 years I worked as an RN, I've disturbed many docs at all hours- :) In the 7 years on disability, I"ve dealt with more hospitalists and residents- the hospitalists were good. The resident I dealt with as a patient was a .........

To be honest, I've rarely had problems with residents. Most are nothing but grateful for our knowledge. In the ICU they were humble and polite. If I was wrong, they had no problems telling me so...

Int he cath lab I only deal with fellows (and attendings, of course). Bigger personalities for sure, but by FAR better, smarter, and were a real part of our team. I love fellows.

But, if need be, I could call an attending in a second if I felt I wasnt getting what I needed for my patient. I've certainly done it though...