Published Jan 29, 2004
I work in a university hospital. We get a new set of residents every month. I have learned so much just by listening to the attendings talking/teaching the residents. However, there have been times when it got reallllly scary. Few months ago - we were getting ready to intubate a pt. She had short neck syndrome and the resident was having a hard time visualizing the cords. It was on the weekend and we have "travel" doctors, who are probably "traveling" for a reason. Anyway, the doctor was in the back office. The resident looks a few times and orders for the succ's to be given. I gave it - and to my horror - the resident coudnt get the tube down. We repositioned the pt and bagged her - but he never did get it. Her O2 dropped sooo fast. !! We finally got the attending travel doc to actually get up out of his chair and come to the bedside. He tubed her easily...but the pt died the next day in icu.She had brain damage due to hypoxia. The "Fellow" chewed the residents butt up for ordering succ's without being sure he could tube the pt. I chewed my butt up for giving succ's without knowing that he could do it. I will never do it again without an attending present. Does anyone else here deal with residents? :uhoh3:
I deal with residents on a daily basis. BUT our ER docs are always at the bedside when a procedure needs done. (ie, intubation, placing a central line, etc)
Most of our Residents are either 3rd year or 4th year so they are pretty good, but once in a while you have a real loser.
Hang in there and keep an eye on them!
I deal with residents every day! We have our "flavors of the month".....the first year monthly rotators and every year above that.
Let me tell you, even the second year residents can screw up and do some stupid stuff! After all, think about it.....this is like their nursing school!!!
But, it's MY job to try to protect my patient's from their screw ups and question the orders that I don't feel comfortable with....and yes, I have gone over their head if I'm still not sure, even after talking with the ordering doc!
As for playing "monday-morning quaterback", well, stop! I wasn't there so I can't make calls about what you did, or didn't do. The important thing is that I bet you'll never make that mistake again! Learn what you can from the situation and try to move on.
Take care and good luck in the future!
We rarely have residents in the ER.
My post is, I witnessed a bad incident when a nurse gave succs and the doc couldn't intubate and the pt died. From that moment on I vowed to only give succs if the anesthesiologist is there to tube and maybe a select few ER docs. SCARY STUFF!!
Originally posted by veetach I deal with residents on a daily basis. BUT our ER docs are always at the bedside when a procedure needs done. (ie, intubation, placing a central line, etc) Most of our Residents are either 3rd year or 4th year so they are pretty good, but once in a while you have a real loser. Hang in there and keep an eye on them!
Hang in there and keep an eye on them!
yea, like the one i encountered who wouldn't address the pt with the chest/back pain and a board like abdomen until he gave a urine specimine. well, needless to say, i went to the attending and the guy was in the or in about 1/2 hour just about to dissect!
Dragonnurse1, ASN, RN
Our hospital has 2 resident programs - internal med and family med. (Our ER medical director dreams of being level 1 :rotfl: trauma ctr). Any way, we get new group every June and I swear they get worse every year. Our residents do not have their attending with them during ER rotation. In fact they only have each other or the 3rd year resident that is always sleeping at night. And yes they tend to scare all of us to death sometimes. I could fill several pages with the happenings but just an example one night the residents accepted a transfer - snake bite - from another hospital (pts bp on transfer 60/0). Bite from pit viper with multiple punctures. Pt arrived not tubed. 2 residents stood over pt arguing about tubing while I called O2 sats like auctioneer- 87 80 75 70 ... Finally ER doc tubed pt. Good thing pt was so drunk he later was able to walk out of hospital.
Recently I was pt is ER where I once worked (Latex allergic) and nurses told my that the residents all said that they were afraid of me because I would tell them how things were in the ER and did not take any of their B*****t.
The worst part was when the residents couldn't decide on lab work and would keep ordering labs requiring multiple sticks. I told them one night - this is the last stick tell me now what you want or I will order one of EVERY blood test in our computer. Boy I have never seen a patient get orders written and sent to the floor so fast. But the little lady did not get another stick for 24 hours.:roll
Residents - #10 reason to be RN -
Someone has to train the residents.
If I have learned anything working in ER, it is definately that NO resident should be trusted with a sharp object. When they have blank order sheet in front of them... a sharp object also includes a ink pen :)
i am all for learning...let's face it - we were still learning when we started....however I agree w/ the previous post...it is the nurses responsibility to know the properties of the meds they are giving and be able to protect their patient...that is the bad thing about succs - it kills an airway and at times can make it impossible to ventilate...
I used to work in a teaching hospital, and oh! how we dreaded the month of June, when new residents made their arrival on the scene. I enjoyed listeneing to the lectures the attendings gave, but it was also stressful trying to keep the newbies on the straight and narrow path. I've always considered it part of the nurses' job to teach the residents -- not just things like policies, procedures, etc, but also how to behave toward the nursing staff and the patients. Remeber, those green interns will be fully fledged doctors in 4-5 years! If they've learned to respect and listen to the nursing staff, they'll be a whole lot easier to work with later. Of course, the nurses in the ER where I was working had a. . . reputation for not putting up with a lot of baloney; I actually overheard a chief resident warning an intern to mind his Ps and Qs if he wanted to survive his month in the ED!
Everyone has to learn, and let's face it, not all learning occurs in the classroom. Sometimes they have to work on a real live patient. It's the nurses' job to keep both protect the patient and guide the resident (and try your best not to let them know you're doing it! Poor fragile egos!). And there are times when it comes in awfully handy -- when my father was admitted to the hospital for chest pain last Labor Day, the cardiology fellow who worked him up was one of the residents I helped to "raise" (he'd been in second year when I first started nursing, so I'd seen him through most of his residency -- including his ER rotation.). I knew his skills and was very glad to see him.
Originally posted by V. Nightingale Everyone has to learn, and let's face it, not all learning occurs in the classroom. Sometimes they have to work on a real live patient. It's the nurses' job to keep both protect the patient and guide the resident (and try your best not to let them know you're doing it! Poor fragile egos!).
Everyone has to learn, and let's face it, not all learning occurs in the classroom. Sometimes they have to work on a real live patient. It's the nurses' job to keep both protect the patient and guide the resident (and try your best not to let them know you're doing it! Poor fragile egos!).
yea but come on, face it. some are just really stupid! but what is worse than being stupid? being stupid and arrogant!
I am sorry you are so down on yourself---learn from it. I have been in the same kind of situation---and learned the same lesson. I don't give succ unless anesthesia is in house or I have seen the doc intubate or RT is there to intubate.
We get a new crop of 3rd years every month. Boy you can learn alot from them---especially toward the end of their 3rd year, but we can get some real winners. Sometimes I think to myself (boy these people could never get through nursing school) just kidding. I like the attitude of the attending doc. If I don't think what they order is appropriate, make them call him or if they are missing something tell them. It works pretty good, and really, I only have had to make a very few of them call.
My question is---what's the deal with the full H&P in ER. (including social hx?) Whatever happened to Problem Focused Assessment??
keep the faith
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