new medical intern on the service.... need advice

ZippyGBR, BSN, RN · Jun 26, 2011

i'd echo the sentiment about answering bleeps

" did you bleep me ?" is not the ideal way to begin the conversation ...

where

" its' Dr covering " or it's "Dr the " is clear and concise as to who you are ...

if you've multiple specialities on one floor/ ward then the nurse(s) may be waiting on several different people to answer bleeps

also the stuff aobut communicating significant changes in the plan or significant 'events' such as ordering off the unit tests

with respct to adding blood tests - find out if the labs will accept tests added onto recent samples ... especially if it;s a sample darwn in the last 6, 12 or 24 hours ...

msjellybean · Jun 26, 2011

i'd echo the sentiment about answering bleeps
" did you bleep me ?" is not the ideal way to begin the conversation ...
where
" its' Dr covering " or it's "Dr the " is clear and concise as to who you are ...
if you've multiple specialities on one floor/ ward then the nurse(s) may be waiting on several different people to answer bleeps
also the stuff aobut communicating significant changes in the plan or significant 'events' such as ordering off the unit tests
with respct to adding blood tests - find out if the labs will accept tests added onto recent samples ... especially if it;s a sample darwn in the last 6, 12 or 24 hours ...

Generally this is what we do. Except when on draw 1 they draw a BMP, then second draw is cardiac enzymes and then 3rd draw is some misc test or blood cx. And etc.

**canoehead, BSN, RN** · Jun 26, 2011

if you have to do something new and your pgy2...x can't hand-hold you through it, never be afraid to ask an experienced nurse to accompany you. tell him/her it's your first one, ask what you should do.

i disagree. we don't know all the teaching points a physician needs to give. we aren't licensed to do the procedure, or to supervise a learner. if we just have a student doc and a nurse at the bedside we don't have the knowledge and backup needed if something goes wrong. if a chest tube comes out with a gush of blood, what then? if the patient passes out or vagals, if the sutures break and you're left with a loose hole...who do you think will want to be your backup? who will trust you after something like that happens?

tokmom, BSN, RN · Jun 26, 2011

It's NOT ok to rip into a nurse in front of everyone at the desk, in the hall or in front of the pt or family. If you have issues with a certain nurse, use your conflict skills and resolve the issue privately. There never is a reason to be snarky. I get tired and hungry at work but I would never dream of talking to an MD or a nurse the way some interns or MD's have talked to other nurses including myself. If you can't come to some resolution, take it to the manager, but let that be your last resort.

Write parameters on certain meds. You might know when you want them held, but I don't. It will keep you from getting those nasty phone calls at 2 am. I can't tell you how many times I have a pt with no pain med orders! :confused:

Nurses will call you at 2am to cover their butts. We need to keep our license too!

If you see your patients nurse at the desk, grab them for a second and go over the orders quickly. It will make a huge difference in time spent on the phone trying to get clarification or the nurse might see something missed and have you add it right then. I work with a PA that gives his 'direct eye contact'. He does it in a silly staring way. It has become our joke, but when you see him standing over you, looking straight at you, you know he has something to tell you. :lol2: We get orders clarified and he leaves satisfied that we understand them and we can look at them and tweak them if need be. We all love this PA to death, because his communication style is easy going, he never gets angry and we always know his plan of care. :yeah:

netglow, ASN, RN · Jun 27, 2011

Remember that you may have brand spankin new nurses on the floor. You guys are pretty much walking the same plank. It's always better to have a few partners in crime, right? That new nurse knows nothing and you know nothing. You will have a lot to go through together.

313RN, BSN, RN · Jun 27, 2011

Congrats on starting your career and thanks for asking to hear our thoughts.

First, read this:

http://katesaid.wordpress.com/2010/0...ff-your-pants/

It will help you remember why we're all here.

Second, communicate, ask questions and explain your reasoning when we ask questions. We'll tell you what we're thinking and what we want/need. All we expect is that you listen, consider and decide. We might not like it if your answer is no, but as long as you tell us why and can offer another option we'll take it.

Third, be a leader. You might not be our boss, but you're still the quaterback when we're at the bedside. Lead by example. Never, ever complain, gripe, carp or kvetch about anything to anyone you're expected to lead. Complaints go up or laterally. I gripe to you, your gripe to your fellow, they gripe to the attending and attendings issue Holy Writ from their pantheons. Be professional and polite at all times. I want to be led, but I refuse to be driven.

Last, remember no job is beneath you. That means you should be willing to empty a trash can, clean up a soiled patient, pick up a meal tray or sweep a floor if it absolutely needs to be done. I know you're too busy to do those things and there are a lot of people around to do them already. I don't expect you to them. I just want to know you're willing to. Never order someone to do something that you won't is what it boils down to.

Best of luck to you.

mike109810 · Jun 27, 2011

Oh wow! I am so impressed with you already because you came to this forum to ask your questions! It is docs like you that I admire, because you see the VALUE in developing good relationships with nurses. Kudos to you!
1. My expectation of interns is that they develop good communication skills. State your expectations clearly and if you have any doubts, ask your PGY2. It never hurts to ask nurses directly what they think about your plans/expectations, but be confident when doing so. Example: I worked with an intern who was a very bright young woman and obviously had her "stuff in a pile". She was organized, decisive, and direct. She learned quickly that certain nurses would be helpful to her and was not hesitant to ask help from those nurses. She had her doubts at times, so she asked pointed questions in order to formulate a sound decision. When she didn't know the technicalities of a simple procedure (i.e., drawing blood for cultures, taking out skin staples, applying a Dakin's dressing), she would find one of us to show her how to do it. She collaborated with her attending, her PGY2/3 and the nurses taking care of the patient to come up with a truly multi-disciplinary approach to care. Needless to say, she was super successful and a favorite among her peers.
On the flip side, I worked with an intern who was quite frankly terrified of everything. She was a bright woman, but she was incredibly insecure and did not trust anything about herself. She was unorganized and did not know the answers to basic questions when she came into the OR to report off to the PGY2. She was skittish and her demeanor did not inspire confidence from her patients. She quit the program after one year.
The point I am trying to make using the above examples is that on the one hand, you should be confident (but not cocky) and on the other hand, you must be brave enough to ask questions prior to rounds so that you don't look like a complete fool in front of your patients and your PGY2/3. Most nurses love to see interns grow and blossom. A good working relationship is key.
2. I think that I answered this question already with the above scenarios. When you are approaching a nurse that you haven't met, introduce yourself and tell them that you will be the intern for X number of months for that service. If there is a whiteboard on the unit (usually at the front desk or in the lounge), write your name and pager number on the board.
3. Pitfalls-oh lordy! There are so many! If you are as organized as you can possibly be, you will have already won half the battle. There is nothing more heart-wrenching to me than to see a new intern pull out a wad of papers, shuffle through them (all the while sweating bullets) in order to answer a simple question during rounds. If you can somehow create a notebook in which you can staple your rounding papers in, it will make your life easier.
One of the most common pitfalls I have seen is a very tired, hungry intern. Mistakes are easily made if your blood sugar tanks because you haven't had time to eat. Keep a jar of peanut butter in your locker so that you can at least have a tablespoon or two before running to put out the next fire. You will be surprised how well this staves off hunger. Also, eat some protein for breakfast. Boil some eggs the night before so that you can throw them in your bag before you go out the door at O'Dark Thirty.
Keep your home study area organized. One of my BFFs is now a Chief, and she is just now getting around to organizing her study. I made files for her and set up some bookshelves, grouping her texts together by subject. You are gonna be dead tired when you come home, and the frustration of not finding something does not make for a good start the next morning. It's much easier to keep things organized as you go.
Make friends with the unit secretary. They will have your back if you treat them with respect. And THEY KNOW EVERYTHING! Seriously, a good unit secretary will know exactly how/when/where to get something if you need it.
Good luck to you!

As a freshly minted intern myself who lurks this site, I want to say thank you to all the replies here, but especially this reply :up: ...going to keep these pointers in mind. Ahh so much sensory overload at the hospital, it can feel overwhelming at times. Let's hope I make it out of this year alive, and hold onto some semblance of my sanity!

Thanks again

doc123 · Jun 27, 2011

Thank you very much to everyone who took the time to answer my questions! Your help is much appreciated.

Additional comments are welcome.

Tarabara · Jul 3, 2011

please, please, PLEASE dont tell pts something just to make them happy when its really not going to happen, because you walk away and the nurses are the ones to have to answer all day why things arent being done. Like my patient yesterday who was promised he was going to have a series of tests that day and really none were ordered so he asked me all day why nothing was being done yet! Also, if you tell a patient you're going to having something done, stop and tell the patient's nurse before you leave the floor. Many times a doc will tell a pt they'll be getting something "right now" but they dont tell the nurse, so when the nurse walks in the room a couple min later and doesnt know about it the pt acts like the nurse is stupid, so frustrating!

linearthinker, DNP, RN · Jul 3, 2011

I say this to you not as a nurse to a physician, but as an older person to a younger one. Hospitals are rife with gossip. Ignore it and form your own opinions about people. You will be glad you did.

I have never had a problem with physician-nurse relationships, and I think a lot of the problems exist only in the minds of people with inferiority complexes (on either side). People are people, not their title. Just treat people respectfully, and you will do fine.

Congratulations and good luck to you!