Residencies: doctors have it figured out

[Amistad]

After chatting with a fourth year med student today at clinical, it occurred to me how vastly different the physician career-path is from our own. Fourth year medical students are undergoing the process of being matched to a residency in the specialty of their choosing. They apply to prospective hospitals and hope to be matched to their top choice, awaiting the chance to learn from their experienced superiors. Then, after gaining some experience, they apply for a fellowship or are recruited to a hospital.

Meanwhile, new graduate nurses face roadblock after roadblock to becoming an experienced nurse. As nursing students approach graduation, they frantically begin the job search, only to encounter "__ years experience required" on almost every job posting. If nursing school is not adequate preparation to be recruited to a nursing position, is our education failing us? How are we to become experienced professionals if hospitals are unwilling to let us grow to this capacity?

I believe the answer to this problem is nurse residency programs. Like medical residencies, these programs assume and even require that the applicant be a relatively-inexperienced new graduate. I feel that like medical residencies, nurse residencies should become a traditional and required portion of nursing training. I envision this to be far off in the future, but maybe someday every teaching hospital will have "nurse residents" and every nursing student will go through a residency as part of their training, not just the lucky few who are accepted to these programs today.

[ThePrincessBride, MSN, RN, NP]

It's probably also worth pointing out that physicians go to school for much longer than we do and bear a larger responsibility with regard to patient outcomes. A slow and diligently managed post-graduate preparation program makes sense.

Put simply, at entry level, it is probably quite a bit harder for a nurse to kill someone.

I disagree. One med error could easily kill a patient.

[SummitRN, BSN, RN]

I disagree. One med error could easily kill a patient.

You seriously think a physician has an equal level of responsibility compared to a RN? Simply comparing the maximum consequence and finding them equal, then concluding there is an equal level of responsibility is a major failure of critical thinking... and logic... and/or a total misunderstanding of the roles of a physician and a RN.

[ThePrincessBride, MSN, RN, NP]

You seriously think a physician has an equal level of responsibility compared to a RN? Simply comparing the maximum consequence and finding them equal, then concluding there is an equal level of responsibility is a major failure of critical thinking... and logic... and/or a total misunderstanding of the roles of a physician and a RN.

Back up for a second. Where did I say that the consequences were equal or that doctors and nurses had the same level of responsibility? I didn't. I did state that it is rather easy for an entry-level nurse to kill someone with a simple med error. Case in point: my clinical instructor had a patient suffering from hypercalcemia. The doctor had mistakenly placed an order for medication that treated hypocalcemia. The nurse noticed this and immediately called the pharmacy. Had she given the med, according to the pharmacist, the patient would have died and both the doctor AND the nurse would have been reprimanded / lost their licenses.

True story. Nurses have a great deal of responsibility. Not only do they have to watch their butts, they also have to cover the doctor's ass as well. You would know this if you had experience in the field...do you?

[FlorenceNtheMachine]

I don't believe that the level of responsibility of nurses are on the same level as a doctor. Are we in dangerous positions as nurses? Yes! Emphatically, yes.

Staff nurses don't get phone calls on patients at home, when they've reported off to the oncoming nurse. We don't have the same level of obligation as a doctor does. Our obligation is gone when we leave, and starts back up when we come back.

Does that make sense at all?

[SummitRN, BSN, RN]

Back up for a second. Where did I say that the consequences were equal or that doctors and nurses had the same level of responsibility?

It wasn't clear which part of the quote you were responding to, and I assumed it was the first part, not the second, thus my response. Sorry we had this misunderstanding (apparently I wasn't the only one to read it that way).

[nursel56]

Both doctors and nurses are at risk for harming/killing patients due to medication errors, but the initial diagnosis process adds a crucial difference. If they get that wrong the consequences can end up to be quite dire - depending on what the patient actually has vs what the doc diagnosed and treated for.

Although I do know that nurses are also the eyes and ears of the medical doctor and really experienced nurses do bring forward their observations - leading to a change in the medical diagnosis. Hopefully we watch out for each other. A really good doctor doesn't get their ego in the way when it seems they may have missed something, just because it was a nurse who provided the input.

[joanna73, BSN, RN]

Residencies might be a good idea, but if nurses are expected to complete a 2 year residency, then the pay needs to increase. Doctors make a lot more than 25 dollars an hour. Really, they would be wise to revamp the system within the BSN program and make that the mandatory entry point. Students would have 4 years of clinical time instead of 2 years, and a one year residency afterwards.

[PMFB-RN, RN]

I don't believe that the level of responsibility of nurses are on the same level as a doctor. Are we in dangerous positions as nurses? Yes! Emphatically, yes.

Staff nurses don't get phone calls on patients at home, when they've reported off to the oncoming nurse. We don't have the same level of obligation as a doctor does. Our obligation is gone when we leave, and starts back up when we come back.

Does that make sense at all?

ER physicians and hospitalists are the same. They don't take calls when they are off duty. The come to work, work their shift then go home. They don't get called by nurses or patients at home.

[FlorenceNtheMachine]

ER physicians and hospitalists are the same. They don't take calls when they are off duty. The come to work, work their shift then go home. They don't get called by nurses or patients at home.

So a couple specialities overrides the vast majority? Ive called hospitalists at home to clarify orders, and so have many of my colleagues. I stand behind what I say.

My stance on the OP would be, I love residencies and orientations. I felt my school prepared me well enough on the tasky things in the hospital. Med admin, making beds, IV and feeding pumps. So I feel like residencies should grow the decision making part of nursing. Should they be longer like doctors? Hmm, depends on the environment.

[PMFB-RN, RN]

So a couple specialities overrides the vast majority?

*** What? Where did you get that? What a strange thing to say.

Ive called hospitalists at home to clarify orders, and so have many of my colleagues. I stand behind what I say.

*** Pretty much defeats the purpose of having a hospitalist program.

My stance on the OP would be, I love residencies and orientations. I felt my school prepared me well enough on the tasky things in the hospital. Med admin, making beds, IV and feeding pumps. So I feel like residencies should grow the decision making part of nursing. Should they be longer like doctors? Hmm, depends on the environment

*** No need to reinvent the wheel here. Nurse residencies don't need to be anything like as lomg as physician. We already have tons of good data supporting 9-12 month residencies. Might have to pry the data out of the hands of the private hospitals that have it though.

[soxgirl2008]

Residencies might be a good idea, but if nurses are expected to complete a 2 year residency, then the pay needs to increase. Doctors make a lot more than 25 dollars an hour. Really, they would be wise to revamp the system within the BSN program and make that the mandatory entry point. Students would have 4 years of clinical time instead of 2 years, and a one year residency afterwards.

I don't know any BSN programs that have 4 years of clinical...all the BSN programs around here have 2 years of pre reqs and 2 years of clinical... The ADN programs have 1 year of pre reqs and 2 years of clinical. If you wanted the BSN programs to have 4 years of clinicals it would take much longer than 4 years to fit in 4 years of clinical time AND pre reqs. Most BSN students here need to take classes in the summer as well just to finish in 4 years with the way it is now.

[LadyFree28, BSN, LPN, RN]

In my area, one university offers a co-op program where students are offered paid student nurse preceptor-ship, at least that's how a few of my co-workers described it...they are able have a full assignment of pts. They were able to have three semesters of focused pt care in between semesters that included clinicals as well. This is a five-year program; students with the four year program have one co-op experience. It ends up being 3-3.5 years of clinical experience.

Depending on the coursework layout of some university programs, people do end up having 4 years of clinicals, including pre-requisites. When I first went for nursing school, for my ADN, I was doing prerequisites along with nursing courses. For me, that was disastrous. When I decided to return to school and went through the PN program, where you are in clinicals within the second week, I knew that I had to separate prereq's and then focus on nursing. The program I graduated from, you were in clinical within the next week. Clinicals rounded out to be about 3 years worth in 2.5 years. But that's how I tailored my education. It worked for me, and was able to find an organization that automatically has a nurse residency program.