Residents and Interns?

[bth44]

Ever since I graduated nursing school, I've worked at a reasonably-sized hospital, and the nurses only work with attendings there. Our hospital is considered a rural rotation. I only time I've ever met a med student was when one came in to shadow a family practice doc for a day, and I think I remember a student touring the hospital with a GP a while ago.

So, the big change for me this month is that I've accepted a position at a very large university hospital in a big city. LOTS of students. A minor concern of mine is what to expect with all the residents and interns running around. I have no idea of the succession of medical student, intern, resident...is it even in that order? What's within each's scope of practice? Do I have to wait for an attending to give a looksee over orders before I act on them? How's their demeanor compared to attendings? Oh...are the attendings cocky because they have students under them?

I'm sure that residents and interns are different from attendings. Can anyone give me any information on what to expect?

[Tweety, BSN, RN]

Ask to see a copy of their descriptions and what they are allowed to do. Interns are tightly under the thumb of their attending MDs and other senior residents, but as they progress this changes. This is a JACHO requirement and should be available to you. I recently saw ours.

Doctors who have just graduated and in their first year of practice (residency) are called "Interns" and then usually "residents" after that.

The "attending" is the one who oversees them all, kind of like their insturctor/mentor/charge MD, etc.

A sad thing I've seen is sometimes nurses mistreat, ignore and are rude to residents because they think they know more than the residents do. (Which is true, but beside the point. LOL)

Good luck.

[indagenes]

Even interns are doctors. They are licensed by the state in which

they are doing their residency. Residents and interns are not, however,

board-certified. A resident's job is TO LEARN. Their learning curve can

be pretty steep.

Before the attending and/or senior resident goes home for the day usually

he/she will chat with the on-call resident/intern to make sure all is lined

up with regards to orders, discharges, etc. for their patients. Who you

contact when you need to get an order or inform an MD about a pt's

condition depends on if it is day/noc shift and who is on-call. Your

nursing unit should be able to help you discern that info.

I really enjoy working with interns and residents, most (not all) are

hard-working people who are ready to learn. Remember, they can

learn a LOT from nurses too, but I usually try to be casual and non-

threatening about teaching them.

Oh, also remember that interns and residents (esp. when on a difficult

rotation) are oftern SLEEP DEPRIVED. If you do have to call them in

the middle of the night, apologize. Usually i say something like "Hey

Dr. (whatever), I'm sorry to wake you, but I really need to let you

know about "blah blah blah". I have never had a Dr. (intern, resident

or attending) be angry with me using this manner.

[P_RN, ADN, RN]

I would never work at a place that DIDN'T have them. You have help at your fingertips 24/7/365.

Ours are called neither one. They are post graduate 1-2-3-4-5 or PG-1 etc.

Different specialties take different numbers post graduate years. Ortho takes 5, Int. Med takes 3 (I think ) Family Practice 2, etc.

Sometimes their PG years take them to other facilities such as the VA, the Shriners' Hospital, etc.

I rather like this way since "intern" brings to mind the Dr. Kildare movies of the 30s and 40s.

July 1 is when they change and it can be chaos but our attendings keep a pretty tight rein.

You call the youngest on the rotation schedule for problems. But you are not limited i urgent cases to calling the chief or even the attending.

[caroladybelle, BSN, RN]

As to what is permitted by the scope of their practice varies from facility to facility.

A medical student is just that, a medical student. they have not graduated from med school and practice is quite limited and heavily supervised. Usually all orders must be cosigned by an intern/resident/MD.

A SubI - subintern - is a med student that has graduated but has not started internship. See above description.

An intern is in their first year out of med school. Can write some orders are but are still limited per the institution in which they practice. Requires less supervision but still a "newby" to many things. Much like a new grad nurse or a nurse on her minipracticum.

After some point in internship (second or third year), they are residents. Requires less supervision, has expanded role, and supervises med students and interns.

Later on, specialist residents become "fellows".

Attendings are the tenured teaching MDs with seniority.

As a general rule, interns and residents are referred to in some places as "House Staff/Officers". Prior to 2003 (or so), they was no limit to the hours required of "house staff" and they were quite literally in "house" all the time with only brief breaks to sleep/see spouses, etc. Recently their hours have been greatly curtailed to 80 hours per week. This rule is frequently "fudged" on or ignored. When a very well known high ranking facility got busted for exceeding the 80 hour rule, it made national news.

As an example of duty breakdown, recently I had a patient that needed an LP with IT chemo placement. The intern prepped the patient, the resident was summoned to observe and monitor the LP and the fellow infused the IT chemo...after the resident and I checked the chemo.

I work high level hemo/onco floors, as such I almost never see a med student.

I also try to be kind to the moonlighter/night float. As a general rule, this poor person may have been up all day, on rounds/in class/in clinic. So they get very little rest. We try to combine all calls at one time, so that they catch a bit of rest.

[TazziRN, RN]

My one experience with residents and interns was when I had surgery at UCSF a few years back. One of the interns making rounds with my surgeon said something flippant to me and I reacted. The surgeon laughed and told the intern it would be in his best interest to treat nurses with respect, be the nurses working or patients.

[hrtprncss]

You'd have to look and ask your coworkers cuz sometimes depending on where you're working some residents who are under a specific attending for the month would not be allowed to write orders somewhere, like in an ICU setting. Some ICU's would only allow the Intesivist's team to write

orders, and they don't even allow that patient's own attending write orders. Also, even during their ICU rotations, at some hospitals a PGY1 won't be allowed to write orders in the ICU. They could be fully functional on the floors, but sometimes they have a specific policy where the more senior residents would be the one writing all the orders....Most likely even the Fellows. It just depends on where they are. You'd get the hang of it, and after awhile you will pretty much know who to page, bypassing the one's who can't help you and go directly to the person who's able to give you orders and answers right away.

[HappyNurse2005, RN]

WE have med students, the interns, residents, attendings, you name it. I've seen them refer to themselves in progress notes as "pgy-1" or write orders that say "page H.O. if....." We have internal medicine, surgery, family medicine come through all the time. Usually means quite a large number of people.