residents in the er

Dave ARNP · Jan 31, 2004

Originally posted by petiteflower
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

This was started because a ER staff member was seen taking a bathroom break. Rumor has it, that someone even had time to take lunch.

Such travisties must not be allowed

Dave, who worked ER the other day and it kinda ticked him off

NeuroICURN · Jan 31, 2004

Originally posted by MAGIK GIRL
yea but come on, face it. some are just really stupid! but what is worse than being stupid? being stupid and arrogant!

We let ALL of our residents know REALLY early on that if you try to mess with one of us.....ALL of the nurses in our hospital (a 900-bed, level 1 trauma center) will make your life a living hell.

I can share these two examples...

(Situation 1) Once, one of our Trauma ICU nurses (Nurse of 20 years) had to take a pt. down for an MRI. She had a 1x order for 1mg of Ativan. Well, this dose was not effective. So, she gave another 1 mg of Ativan, wrote the "verbal" order and signed the 1st year resident's name to it (he was only 20 days out of med. school at the time). That got the pt. through the MRI and when she returned to the ICU, she told the resident what she did. He said NOTHING to her, NOTHING to her supervisor and immediately went up to the legal dept. and had her fired!!!

Everyone was ticked! Granted, technically she was in the wrong, but it's something that all of us have done a thousand times to get someone through! So, in retaliation, all the trauma ICU nurses refused taking any verbal or telephone orders (except emergencies). The residents all had to come to the dept. to write even the most trivial Tylenol order! Even the 6 other ICUs quit taking verbals too for a while!

On top of that, the other MDs stood behind HER! Several wrote letters to our union and to the hospital stating that if she had just come to them, they would have signed the order! Long story short, she got her job back! (and I'm pretty sure that resident is long gone now!) :roll

(Situation 2) My unit has two 2nd year residents. Well, at first, the one was very nice and the other was a real jerk. So, the complaint was taken to the chief resident, who, in turn, knocked the 2nd year off his high horse! LOL Now, that one is VERY personable, more relaxed (this happened at the beginning of his second year) and a pleasure to work with. Now the other one thinks he can do no wrong and is EXTREMELY arrogant. We again went to his chief (my nurse mgr. and he have a great working relationship), the chief talked to him. No change. Long story short, we've now worked our way all the way up the ladder to the head surgeon in charge of it all.....I can't wait to see how this plays out! The resident is skating on some VERY thin ice and I hope he gets booted from the program! We could do it with just the one next year!!!

So, what's the moral of the story? If you're a resident, don't mess with the nurses!

ShelleyERgirl, LPN · Feb 1, 2004

Alright guys, stupid question from the student:p ...... What is "succs" that you give before intubation? Is is Versed or something similar?

teeituptom, BSN, RN · Feb 1, 2004

Well Navynurse

Its also called anectine, or succinylcholine, to long to call it thats easier to say sucs

And to the thread, I just thank god I work in a Private hosp, all our ER docs are all board certified, no flipping rookies or residents or interns or students at all.

I did my time at parkland, got tired of babysitting all those newbies who thought they were better.

ShelleyERgirl, LPN · Feb 2, 2004

Thanks for the answer Tom :)

MAGIK GIRL · Feb 2, 2004

Originally posted by teeituptom
Well Navynurse
Its also called anectine, or succinylcholine, to long to call it thats easier to say sucs

And to the thread, I just thank god I work in a Private hosp, all our ER docs are all board certified, no flipping rookies or residents or interns or students at all.
I did my time at parkland, got tired of babysitting all those newbies who thought they were better.

succs is like pavulon. it is a neuromuscular block. if you give it muscle activity stops but the pt can still hear, see and feel! :devil:

mommatrauma, RN · Mar 6, 2005

We have both ED resident program and IM resident program along with 4 million fellowships and other rotations....Our primary ED residents are fairly decent...ours is a 4 year EM residency...so we get to raise the guys like they are our children...as my mom always said get 'em young train 'em right (ER nurse for 20 years!!) I always make it a point of taking my vacation the first week in July...that's when they start...I need to clear my head...but much like having new nursing orientees...it keeps you on your toes...because you have to know what you are doing to prevent an intern who has been a doctor for 10 minutes from intubating the unresponsive diabetic without making sure they aren't just hypoglycemic first...Our attendings are very in tune to what happens in our ED, we have 3 attendings on during the waking hours and 2 from 9p-7a...They are present for every intubation...a senior resident can monitor the CVP placement and LP...Our attendings and senior residents are very supportive of our nursing staff and work as a team not as superiors...cause god knows, somewhere down the line a nursed saved their a$$ more than once....when it gets a little painful is when we have the specialty fellows rotating through their ER rotation...it takes them 5 x as long to get a history and physical...and they are needy...If I'm concerned that someone is sick and I think the intern/resident is taking too long to make decisions...i take it to the attending...and let them deal with it...also, if they are not ED residents, all orders must be approved by a senior or the attending before they can be done...which is good practice...I certainly don't want the Optho resident coming down and consciously sedating me and doing my sutures without talking to someone who knows whats what...

Peg804 · Mar 8, 2005

Residents rotate thru out ED from the mother house-Geisinger Medical center. and some have been great-please come work here-to the ones that you wonder who has tied their shoes. I wish we as nurses were the one to evaluat the residents, not the docs. Unfortunately we have little say. One of the last residents was the best. he was and ED Doc. unfortunately ome are nor. :crying2:

Peg804 · Mar 8, 2005

OH, I amost forgot about our ortho residents. One need a good shot to the had, he is the most arrogant SOB you want to see, he has made sexual comments to one of out EDTs he has also given-yes taken the syringer off the ED nurse and made the patient unconscious for reduction. to the point of requiring artificial ventiolation. He is sad and pittiful and maybe if I have the energy after 13 hrs of he**** I will contact the attending OH Well :crying2:

grammyr · Mar 8, 2005

Thankfully, the only "residents" in our ER are the ones who move in when they decide we are a nice place to visit and be waited on.:chuckle Our ER docs are all regular and great to work with(most of the time) unless they have been there 36 hours.

ernurseafterall · Mar 11, 2005

We all need to learn and start somewhere. My only issue is when recently a resident asked my asthmatic patient who was clearly in a crisis and struggling to breathe, "why are you here today"...the patient and her Dad looked like she wanted to rip her mask off and choke the resident. I was just stunned.

The only other issue we have on evenings when they are taking forever to write orders and then have these long conferences amongst themselves before they even review with their attending. Esp when the patient is stable and the bed is ready and we need beds in the er.

teeituptom, BSN, RN · Mar 13, 2005

Im Glad we have no residents in our ER, everything works better when you dont have to babysit residents