teaching hospital/residents vs traditional

[mediatix8]

I was offered a job at a teaching hospital and am worried about not knowing what it is that the residents do and don't do. I was curious if anyone has any insight on what it is like working in a teaching hospital with residents. Just what do they do, exactly? Do they make your life easier or more difficult and how so? Let me give you the following scenerio. I work night shift (in a traditional hospital) and last night I had a patient that had about a 9 beat run of V tach. Then she converted back to 1st degree AV block. I called her attending, who is famous for not calling back. He did not call back, naturally. It took a while for us to do the EKG because the patient was basically refusing- she had some major anxiety issues and this was not helping the situation. She was refusing to lay down (even just a little bit) because she was too SOB. She was clearly declining and her SBP was over 200 and then another nurse came in and said the monitor was going off v tach again. Then she converted to SVT. We did get the EKG done. Well then I called her pulmonologist since the attending didn't call back and he ordered nothing more than a cardiology consult. So I call the cardiologist and he ordered a transfer to CVICU with a cardizem drip and labs, lasix, other orders. So then she is transfered to the unit where she gets the cardizem and everything. So how would this situation be different at a teaching hopital? I'm imagining I'd be calling the resident who would actually answer the phone and come running over, right? And would they be able to order the cardizem or would I have to call a "real doctor" or would they call the "real doctor" for orders? Are the residents just general medicine or is there a such thing as a cardiologist resident? A GI resident? A hem/onc resident? If a consult is ordered would it be a resident that the consult talks to when they call to find out why they are on consult?

Also, do residents typically insert NG tubes- if not, will they if you try first and are unable to? Would they insert IV's or get labs if nursing was unable? When I was a nursing student I remember a resident inserting an IV but I can't remember what the circumstances were. In the morning when the critical results come out are all the residents basically around so you just make sure they saw it?

Sorry so many questions! If there are differences at different hospitals I'd be happy to hear everything!

[cardiacRN2006, ADN, RN]

The difference would be that the resident would be in your unit after the first call. He would give you all the orders you need, and end it with, "what else do you want/need". Plus, I don't at all feel bad about asking for things. You will never get shot down, or made to feel a fool when you call and ask for something.

Also, I've called residents before, and had then not call back within a few minutes. Then I call the attending, and all of a sudden, here's the resident on the floor all apologetic.

I love teaching hospitals! They are fabulous!

[Dolce, RN]

I also love teaching hospitals. The residents are great about calling back and addressing the issue in a timely manner. They don't always know what to do in every situation but they are great about taking suggestions.

[mrsalby]

I too love teaching hospitals and would hate to work anywhere else. Our residents stay in our unit unless called to trauma. Their on call rooms are in our unit. They always are quick to respond when needed. Also, the residents are wonderful at explaining plan of care and answering questions when I have them about things new to me. They have never made me feel stupid or less than their colleague. I even had had them help with the puke pan and help turn patients.

[All_Smiles_RN]

I too love working at a teaching hospital. Typically, the residents answers calls quickly and will come to the floor if need be. As others have said, they are open to suggestions and don't blow you off. They also give rationales for their orders, which I love! They do not start IVs and NGs (in my experience), but if a central line is needed, a surgical resident will come start one. There can be drawbacks too; their very first week of their first year for instance ;-) If for some reason you really disagree with what they are or are not doing, you can go to the attending. Personally, I have not had to go to that extent. All in all, I'd take a teaching hospital any day over a traditional one.

[Ruby Vee, BSN]

teaching hospitals are wonderful! the resident is always there, and would have been standing at the bedside, assessing your patient and writing orders for whatever you need. as others have said, they're good about explaining their orders and the rationale for them. occaisionally they write dumb orders (lidocaine for an idioventricular rhythm, for example) but if you explain to them why you think that's the wrong order, they'll usually get it. if they don't you can go over their heads. you can also learn a lot from participating in teaching rounds. and you have a chance to educate the residents in how to work with the nursing staff. that's a wonderful thing! nurses everywhere will benefit from your input.