Have you encountered useless residents?

VANurse2010 · Nov 1, 2015

I don't consider that useless as much as the mistake of an inexperienced doctor. I'm not blaming you, either, but in the future if you continue to have concerns you should consider escalating over the resident.

kp1987 · Nov 1, 2015

Lol don't get me started

OnlinePersona, LPN · Nov 1, 2015

Lol don't get me started

Do tell

AJJKRN · Nov 1, 2015

I don't consider that useless as much as the mistake of an inexperienced doctor. I'm not blaming you, either, but in the future if you continue to have concerns you should consider escalating over the resident.

Adding to VANurse2010's suggestions, I have found that telling a resident what you want helps advocate for the Pt and then you guys can get to learn together. It wouldn't have hurt to have done some serial trop's and maybe a D-dimer, which the resident may have been open to if suggested, or even asked for the CXR if you felt it was needed. Collaboration is key to excellent Pt care.

blondy2061h, MSN, RN · Nov 1, 2015

I'm curious how long you've been a nurse. It sounds a bit like you expected the resident to totally take care of whatever was up with the patient. Often times with residents, you need to nudge them toward what you need, and stay on top of them if the patient isn't improving. I'm not judging you at all, but I'm moderately experienced, and remember my novice days well and see myself from those years in this post.

RNperdiem, RN · Nov 1, 2015

I only ever had this kind of problem when dealing with the dreaded overnight "cross-covering" resident. These docs don't really know the patient that well since they are covering other services, and unless the patient is going downhill fast, they tend to "band-aid" over problems overnight until the regular doctors take over. Frustrating at times.

dudette10, MSN, RN · Nov 2, 2015

Chest pain, SOB, diaphoresis...on an unmonitored floor at my workplace, it would have been a rapid response. On a monitored floor, nurse immediately gets an EKG per protocol and trops x 3 will be drawn.

What were the VS? How long have you been a nurse? If you are a newer nurse, what did your more experienced colleagues say? If you're an experienced nurse, why didn't you advocate for the patient and get that EKG and the trops? What was the bigger picture of the patient? Was the VTE risk score high? Was there any reason to think the patient might have been developing a PE? His presentation was more ACS than PE in my opinion, but you haven't given the bigger picture, so I can't say with 100% certainty.

I have my issues with the interns at times, but they are usually open to collaboration as long as we nurses don't treat them like know-nothing morons.

There's a charge nurse on one of the floors I usually work on for which the extent of her nursing interventions is "I told the doctor." She sucks as a charge, and she sucks as a nurse. Sometimes, you need to push harder to get the patient the basic treatment his/her presentation is calling for.

Been there,done that, ASN, RN · Nov 2, 2015

With ANY change of condition, when you request ANY physician assessment..if you feel the orders were not appropriate/adequate... you MUST advocate.

If this means further communication with the resident , or going above their head.. so be it.

Obtain the orders you expect. Enlist the aid of more experienced nurses, nursing supervision, or call the attending at home.

Pulmonary embolism is a catch all for unexplained demise.

Yes, this death MAY have been avoided.

vintagemother, BSN, CNA, LVN, RN · Nov 2, 2015

I'm curious how long you've been a nurse. It sounds a bit like you expected the resident to totally take care of whatever was up with the patient. Often times with residents, you need to nudge them toward what you need, and stay on top of them if the patient isn't improving. I'm not judging you at all, but I'm moderately experienced, and remember my novice days well and see myself from those years in this post.

I was thinking along these lines, too. In my nursing practice, I learned to ask for what I want. I was fortunate to deal with mostly one doctor for most of my pts. He would give me what I asked for in most cases. The fact of the matter is, we nurses are on the front lines and see the pt more than the MDs do.

Interestingly, I've not seen my coworkers or instructors ask for specific orders.

VANurse2010 · Nov 2, 2015

I was thinking along these lines, too. In my nursing practice, I learned to ask for what I want. I was fortunate to deal with mostly one doctor for most of my pts. He would give me what I asked for in most cases. The fact of the matter is, we nurses are on the front lines and see the pt more than the MDs do.
Interestingly, I've not seen my coworkers or instructors ask for specific orders.

It depends on the culture of the unit/hospital. In teaching hospitals, which the OP is obviously working in, I feel like asking for orders and offering suggestions to interns and residents is expected. At community hospitals where you're mostly or exclusively dealing with attendings, asking for specific orders may or may not fly, depending on the physician, service, and what's being asked for. Suffice it to say, though, there is a difference in tolerance of nursing assertiveness between the two.

dudette10, MSN, RN · Nov 2, 2015

It depends on the culture of the unit/hospital. In teaching hospitals, which the OP is obviously working in, I feel like asking for orders and offering suggestions to interns and residents is expected. At community hospitals where you're mostly or exclusively dealing with attendings, asking for specific orders may or may not fly, depending on the physician, service, and what's being asked for. Suffice it to say, though, there is a difference in tolerance of nursing assertiveness between the two.

I have worked in both, and I concur with the differences in expectations between a teaching and nonteaching hospital.