Happy July, Fellow Nurses

[Ruby Vee, BSN]

It's the first of July, the traditional day when new interns start their internship, interns become residents and residents become fellows. July is well known to be the most dangerous month to be hospitalized, not because the hospital isn't air conditioned but because of the plethora of doctors new to their role and perhaps not as competent in that role as they will be next June. Or as they were just a week ago, in their previous role.

July is tough for seasoned nurses, not only because of the medical staff but because of the plethora of new nurses who have just gotten off orientation, will soon get off orientation or who firmly believe that they're too smart and too knowledgable to even need orientation. It's difficult to reason with — or teach — someone who is convinced they already know everything, and that goes for both the medical staff and the nursing staff.

If you work in a teaching hospital, part of your role is to teach the doctors. Their view of nurses for their entire career is based on the interactions they have with nursing staff in their formative years” in the teaching hospital, and most of the nurses who work in a teaching hospital are fully cognizant of this. We know we're going to be called upon to teach when we take our jobs in the teaching hospital, and most of us take it seriously. It' just as easy to teach” the residents to look upon nursing as colleagues and team members as it is to teach them to look upon nursing as antagonizers, aggressors or obstructionists.

In July, you're going to find physicians who are doing it wrong.” It's part of our job to teach them to do it right.” And it's our job to do it in such a way that they learn from the nursing staff rather than hate us.

Almost everyone (except the patients) knows that the experienced ICU nurse who asks pointedly Are you sure you really want to do that DOCTOR?” is really saying You REALLY don't want to do that, you ignorant moron!” I've seen attending bring their herds of newbies around to meet the ICU staff and actually explain this to them. This is Ruby. She's an experienced ICU nurse, and she can teach you a lot. I don't ever want to hear about you disrespecting her, and if she ever calls you doctor” it means you're screwing up. Stop what you're doing and call your Fellow to ask for advice.” Most of them learn from that, but there is one new resident every year who insists that his first name is Doctor” and thinks that he knows more than the experienced ICU nurse. Few of them go on to be respected, successful practitioners. It's the MDs who know (or learn) how to listen and to learn from the nursing staff who become expert and well respected practitioners.

So welcome to July. If you're fortunate enough to have new interns and residents to teach, teach them to value and respect their nursing colleagues. Future generations of nurses will thank you.

[dirtyhippiegirl, BSN, RN]

That July being the most dangerous month to be hospitalized thing is a myth.

[meanmaryjean, DNP, RN]

Our peds ICU is in the children's hospital, connected by a back hallway to the adult ICUs in the 'adult' hospital. Last night, this very frightened looking newbie resident in a brand new white coat was found wandering in a hallway temporarily devoid of patients. He had gotten lost on his first night of residency, and ended up in our building.

We re-directed him, he was EXTREMELY relieved, and I told him to leave a trail of breadcrumbs next time he wandered off!

[NicuGal, MSN, RN]

It is a rough month for sure. I get tired of repeating....look at the med guidelines, have you ever done this before, don't touch that baby unless you want to carry him around the rest of the shift.

I really don't mind helping them, but geez, some just don't listen.

[Ruby Vee, BSN]

That July being the most dangerous month to be hospitalized thing is a myth.

Oh really? Is there some new evidence based article that says so?

[OhioCCRN, MSN, NP]

Alas ... Had that experience last night @ work. Resident saw me stringing up some Levo ( maps of 48) and was all " we don't need that... It's overkill "

Nope.

My patient is not going to code because you just rotated from dermatology.

[Here.I.Stand, BSN, RN]

Myth or reality (admittedly, I have not read the research on this), this post is spot on, VERY sage advice.

[dirtyhippiegirl, BSN, RN]

Oh really? Is there some new evidence based article that says so?

Just from wikipedia, the sources cited at the bottom of the article:

Other studies searching for the July effect have found variable evidence of an increased risk, with several studies finding no risk at all.^[2]

• A 2010 scientific review published in the Journal of Surgical Education found no July effect for patients with acute appendicitis.^[6]
  
• A 2010 study published in the Journal of Trauma found an increased risk of errors that resulted in preventable complications but these errors had no significant impact on mortality.^[7]
  
• A 2009 study published in the Journal of the American College of Surgeons found no month-by-month differences in outcomes of medical trauma patients.^[8][9]
  
• A 2009 study published in the Journal of Stroke and Cerebrovascular Diseases found no evidence of the July effect for patients with acute ischemic stroke.^[10]
  
• A 2009 study published in the Southern Medical Journal found no difference in the medical management of patients with acute cardiovascular conditions.^[11]
  
• A 2008 study published in the The American Journal of Surgery found no seasonal difference in outcomes for cardiac surgery patients.^[12]
  
• A 2007 study published in the Annals of Surgery found a significant seasonal variation with surgical outcomes, with an increase in postsurgical morbidity andmortality associated with the beginning of the academic year.^[13]
  
• A 2006 Journal of Neurosurgery: Pediatrics study found a small increase in the risks associated with cerebrospinal fluid shunt surgery in children during the months of July and August.^[14]
  
• An 2003 Obstetrics & Gynecology study found no July effect in obstetric procedures.^[15]
  

[NicuGal, MSN, RN]

You do know that Wikapedia is not a valid source due to the fact that anyone and their brother can go in and alter anything in there, right?

And that there are many, many near misses that are picked up by nursing and pharmacy before they reach the patient.

[klone, MSN, RN]

You do know that Wikapedia is not a valid source due to the fact that anyone and their brother can go in and alter anything in there, right?.

Do you think those studies were made up? Wikipedia is not a valid primary source, but its references are generally valid, and all it takes is a simple google of the cited studies.

Here are some from EBSCO/Cinahl/Medline:

Ravi, P., Trinh, V. Q., Sun, M., Sammon, J., Sukumar, S., Gervais, M., & ... Trinh, Q. (2014). Is there any evidence of a "July effect" in patients undergoing major cancer surgery?. Canadian Journal Of Surgery. Journal Canadien De Chirurgie, 57(2), 82-88.

Ford, A., Bateman, B., Simpson, L., & Ratan, R. (2007). Nationwide data confirms absence of 'July phenomenon' in obstetrics: it's safe to deliver in July. Journal Of Perinatology, 27(2), 73-76.

Here is a Cochrane review that found a mortality increase and decrease in efficiency at turnover time, but was mixed on morbidity and medical errors:

Young, J. Q., Ranji, S. R., Wachter, R. M., Lee, C. M., Niehaus, B., & Auerbach, A. D. (2011). "July effect": impact of the academic year-end changeover on patient outcomes: a systematic review. Annals Of Internal Medicine, 155(5), 309-315. doi:10.7326/0003-4819-155-5-201109060-00354

[NicuGal, MSN, RN]

Just saying, don't rely on Wikapedia

[Mavrick, BSN, RN]

I would be curious if they differentiate between University teaching hospitals and non-teaching hospitals? The rotation of Residents only happens in teaching hospitals.