Issues with residents

[Rocknurse, MSN, APRN, NP]

I am a third year AGACNP student in a clinical rotation in a surgical ICU team. The team is small and consists of the lead APRN, the attending, myself and perhaps one other NP student and lately a couple OBGYN residents who are doing a short rotation with our team to gain experience with surgical adults. I am having an issue with these two residents and their attitude towards me and I had such a bad day the other day that I really had to bite my tongue.

Right at start of shift we had a rapid response on the floor that my preceptor (the APRN) and I had to run to so the resident was asked to take report from the night NP and give us report on our return. When we came back we were sitting in the area where we work (a small area with 4 computers). We were all sitting in a circle and she rolled her chair in front of me and turned her back on me and started to give report in almost what I would describe as a whisper, speaking only to the attending. I asked if she wouldn't mind speak up a little so I could hear or perhaps move back so she didn't have her back to me. I actually had to ask her twice because she ignored me the first time. I couldn't hear what she was saying since she had her back to me, and my patients were extremely sick and complex and I really needed to know what was going on with them as I didn't know them at all. The second time I asked her she just told me I could "go and stand over there" and pointed to the other side of the desk. Then later, I was trying to help my preceptor place an order in Epic because we just went live with it and she doesn't know how to use it. The resident constantly talked over me and wagged her finger in my face, interrupted and said "just a minute" and stood right in front of me almost stepping on my toes so she could help the NP and look like the golden girl. I really wanted to tell her that I am actually a certified Epic analyst but I didn't want to start a scene.

All through rounds, no matter where I stood, she moved in front of me and turned her back, getting in between me and the attending multiple times, no matter where I moved. I kept trying to hear the attending but wherever I stood she pushed me out of the way. One time I tested it to make sure I wasn't crazy and stood right next to him and his computer and she almost trod on my toes trying to push me out of the way. The other resident treated me with the same disdain. We each were working off our own computers and I got up to check something on a patient and when I came back she said "I took your computer". No apology, no explanation. Apparently hers shut down and as she is much more important than me she just took mine and I guess I can just deal with it. I had to go work on the other side of the unit away from my preceptor who I am supposed to be working with.

I have never experienced anything like this before. It's so ridiculous. I really wanted to tell her that I've been a nurse, and in critical care, for longer than she's been alive but again, I'm in a rotation and I was on my best behavior, but I'll be darned if this precious millennial is going to disrespect me like this. It's absurd. I'm twice her age and know a thing or two. She may be a doctor but she's still green behind the gills, no matter if I'm a student or not. It was her first day in the unit, and I've been there for 3 months. The team is small and should be inclusive. I have my own patients and write my own notes, it's not like I'm helpless or clueless. How can I deal with this? If she wags her finger in my face one more time...

[Corey Narry, MSN, RN, NP]

Very interesting...I've never seen something like this happen to this extent actually, and I've only worked as an NP in settings where there are all types of students (NP, medicine, pharmacy) and residents of various programs. How did your preceptor respond to this? clearly, he/she would notice it and would see how inappropriate and unprofessional this behavior comes off. If this were me, I would talk to my NP preceptor and go from there.

The preceptor has the ultimate responsibility for your learning and should have the backbone to advocate for you. Resident behaviors good or bad are unfortunately not typically under the jurisdiction of APN's because they have their own program directors. It's also an odd situation because you're talking about OB-Gyn residents who are typically an outlier in an ICU rotation (most residents are in more critical care-aligned specialties such as IM, EM, anesthesiology, general surgery). Hopefully your preceptor addresses the issue and brings it to the chain of command.

[Rocknurse, MSN, APRN, NP]

Thanks Juan. No, I've never experienced anything like this either. It was literally her first day on the unit...it was preposturous. Unfortunately, my preceptor is a little odd herself, and as I'm not there for too much longer I hesitated to bring it up. I'd rather pick my battles carefully. It was a horrible day...very busy with rounds that took 5 hours, so I basically had 5 hours of being pushed around and ignored. It's not the best rotation experience I have to say...glad it will be over soon.

[Corey Narry, MSN, RN, NP]

That is the better option in most cases, Rocknurse. However, if your overall impression of the rotation with this team is not favorable, I think you also owe it to future students to provide evaluation and recommendation to your program that this might not be a clinical site worth keeping on the list.

[traumaRUs, MSN, APRN]

What a (bad word inserted here)!

Agree with others and your own feelings: pick your battles while a student. Get as much as you can from this rotation but certainly give the school a heads up.

[BostonFNP, APRN]

I had a similar situation one time but it was while I was working as an NP.

We attend our own patients at a local community hospital that is not a teaching hospital but at times our specialists have residents rotating. All the providers work together very well and everyone is on first name terms, regardless of their education credentials.

So the specialist comes to chat with me as I sat at the orders station about mutual patient. Introduces his first year resident as "Jane". We discuss the patient and "Jane" comes with me to visit the patient. We get back and start to talk to the nurse about the plan. I mention that "Jane feels that pt should have XZY" but I feel that we need to do Y first and move from there. "Jane" buts in as says "actually its Dr. Doe and this really isn't up for debate". So I just nod at the nurse and pull "Jane" aside, and "Dr. Doe" proceeds to reiterate that she is a physician and her expertise has been requested on this patient and the plan should be followed as discussed, so she got a little perturbed and agitated at my audacity when I told her that as the attending provider we would no longer need the consultation and I would be removing the order that I placed for the consult.

I guess she went and told her attending because shortly afterwards I was leaving the floor and the attending was dressing her down in front of the entire nursing station like I had never seen I almost felt bad for her. The very next morning I saw "Dr. Doe" tell a RN to "give her the room immediately" while doing an admission because her "time was valuable and nursing can wait". Some people never learn.

[Rocknurse, MSN, APRN, NP]

I had a similar situation one time but it was while I was working as an NP.

We attend our own patients at a local community hospital that is not a teaching hospital but at times our specialists have residents rotating. All the providers work together very well and everyone is on first name terms, regardless of their education credentials.

So the specialist comes to chat with me as I sat at the orders station about mutual patient. Introduces his first year resident as "Jane". We discuss the patient and "Jane" comes with me to visit the patient. We get back and start to talk to the nurse about the plan. I mention that "Jane feels that pt should have XZY" but I feel that we need to do Y first and move from there. "Jane" buts in as says "actually its Dr. Doe and this really isn't up for debate". So I just nod at the nurse and pull "Jane" aside, and "Dr. Doe" proceeds to reiterate that she is a physician and her expertise has been requested on this patient and the plan should be followed as discussed, so she got a little perturbed and agitated at my audacity when I told her that as the attending provider we would no longer need the consultation and I would be removing the order that I placed for the consult.

I guess she went and told her attending because shortly afterwards I was leaving the floor and the attending was dressing her down in front of the entire nursing station like I had never seen I almost felt bad for her. The very next morning I saw "Dr. Doe" tell a RN to "give her the room immediately" while doing an admission because her "time was valuable and nursing can wait". Some people never learn.

Ha! Excellent! I wish I could have been a fly on the wall for that one! I guess she likes to learn the hard way (or not)!

It's funny but the second week of my rotation my professor came up to me and asked if everything was ok because they had had reports that the APRN who is my preceptor had had lots of complaints about her attitude and poor teaching style and wanted to know if I had an issue. I'm like...gee, thanks for placing me there! I gave her the benefit of the doubt as I just wanted to learn and make it a good experience but now as I'm coming to the end I have to say it was really a poor rotation and I will be reflecting that in my evaluation.

She is dismissive, likes to show off, argue with you, spout the fact that she knows so much more than everyone else, makes you feel stupid and humiliates you in front of others and ignores you the rest of the time. There's precious little teaching and teaching only occurs if she thinks I missed something or did something wrong which she loves to point out loudly so she can proceed to tell me loudly how it's really done and how stupid I am for not knowing that. She did my midterm evaluation in the lunchroom with everybody listening...it was so embarrassing. When I went to put in my first lines, if I didn't hit it within 3 seconds...I'm not exaggerating...she'd rip everything out of my hands. I didn't even get an opportunity to try. Yeah, can't wait to be done here.

The residents I'm not even going to bother rising to. You're all correct...it's not worth it. I feel I have a lot to offer and a lot of valuable experience and to go in there and give up my precious weekends to be treated like this by all and sundry is just training. I am so eager and so enthusiastic but people like this drain the nice out of me. The younger me would have gotten all up in her face with some choice words, but the older me is just too darn tired. Soon it will be done and I'll move on, but this has put me off critical care for the time being. I just want to work in a place where people are nice to each other and respectful. I'd rather give my energy to learning and doing my best for the patient.

[core0]

Just like anyone else residents are a bell curve. Most will be average, some will be excellent and the rest - well meh. Fundamentally, the attending is responsible for GME residents. They should be aware enough about what's going on to step in and correct the resident. Another response if things bet bad enough most hospitals have a professionalism complaint system to use. If your almost done, its probably not worth the effort. I would definitely be honest in evaluating the rotation.

I work in a large SICU and we have 3-8 residents per month. Most are great, some have a true passion and occasionally we have problems. The residents are given a manual which outlines the expectations, an orientation to the unit and told what to expect. First time they get time with the attending, second with the unit medical director, third time is the medical director talking to the residency director, and finally (only happened once) the medical director talks to the department chairman. Rarely gets to level 2. We had a similar problem a few years ago where the resident did not want to work with women. Our entire night crew is female. After the second night on call our medical director showed up in rounds and pulled the resident aside for a fairly intense discussion. This didn't totally fix the attitude but made it bearable for the month.

[CCU BSN RN]

We had a similar problem a few years ago where the resident did not want to work with women.

Are you kidding me? This resident sounds like one of God's EXTRA special children. Where, pray tell, does this resident plan to work when he grows up, where there are no women? Is he under the impression that none of his fellow MDs will be female?

Thanks for the laugh, though, that was obscure and I wasn't expecting it. I literally laughed out loud because I can picture these extra special residents.

[Rocknurse, MSN, APRN, NP]

Are you kidding me? This resident sounds like one of God's EXTRA special children. Where, pray tell, does this resident plan to work when he grows up, where there are no women? Is he under the impression that none of his fellow MDs will be female?

Thanks for the laugh, though, that was obscure and I wasn't expecting it. I literally laughed out loud because I can picture these extra special residents.

It happens more than you'd think!

[CCU BSN RN]

Rocknurse- I'm sure it does, I just think it's ridic that someone would be allowed to say that out loud in a professional environment, in 2017. Oh, how tolerant and evolved our fine country is.

[Julius Seizure]

Rest assured, the rest of the team sees her behavior. She is building her own reputation. Good job being on YOUR best behavior during your time there. The team sees that, too.

If you felt that you needed to, you could speak privately and objectively with your preceptor about your concerns that the dynamic might be impacting your ability to get the most out of your clinical time there, and ask for your preceptors advice. However, I agree with what you said about that not being worthwhile since you won't be there much longer. Just get what you can out of your rotation. I, like you, am just too tired to deal with people like that.

As a side note, I was 100% sympathetic until I got to the words "precious millennial". While still mostly sympathetic to you, I found that last paragraph a bit off putting. I would definitely avoid that in any conversation that you might have with your preceptor about it - but I am very sure that you would never do that anyway!

Again, keep up being as professional as you possibly can - you can only control you!