I taught an ACLS class this afternoon, and all the participants were 4th year medical students. They're scared and excited about being real DOCTORS in a few months! One of the topics that came up was how to be on good terms with the nurses. I came up with a few ideas right off the top of my head, but what do you guys think? What would you tell them?
The first few things I thought of were:
Don't ever tell a nurse your first name is "doctor." Your mother gave you a first name, and although I have known a few MDs with the LAST name of "Docter", I haven't ever met anyone with a FIRST name of "Docter." And nothing irritates an experienced nurse MORE than being asked to call some kid 30 years younger than herself "Doctor Smith." I'm likely to say "then you can call me "Mrs. Vee." You don't want that.
When you come to see my patient, tell me who you are. And don't ever tell me "I'm his doctor." We have a lot of those in most hospitals. Are you the psych consult, the cardiologist who admitted him, or the nephrology resident coming by to evaluate him for dialysis? It would be nice of you to say "Hi, I'm Althea. I'm the pulmonology resident here for a consult."
Bring us chocolate. We like chocolate!
So what would you guys like to tell the new residents who come to work with us?
I forgot- don't hit any buttons, it looks easy, but I'll beat you with a wet noodle because of past experiences with unintended boluses. Not even "silence," just hit the nurse call button if you need help. If you hit "OFF" your attending will do the beating, so don't do it. Even the attendings leave our various alarms and buttons alone, they are dangerous.
ROFL Canoe! I busted out laughing when I read this... (pump button) :pntlft:
No. He was detailing the role of the nurse to other nurses. Either way though, one discipline is different than the other. They can be general about it, but leave the specifics of it to those in the correct discipline.
Basically the physician should have changed his word choice in his presentation. What physicians look for. . . As nurses, what would you look for--and let the appropriate nurse educator take the lead with the nurses in the class on that.
One more example of unequal amounts of respect between the disciplines. He can speak to medical things. The appropriate nurse/nurses should speak to nursing things.
I work in a teaching hospital, and I would LOVE to leave a list of tips for these wippersnappers!
+ I am with "your" patient 12hours a shift (often more than one shift in a row) and if I think it would be helpful for the patient to have an order for MiraLAX, simethicone, a suppository, etc., please consider it. I am not the doctor, but I do know my patients. There PD will not work if they aren't pooping....you will learn this too!
I appreciate this sentiment, but it should be used sparingly during late night hours. This is an appropriate page at 5 PM, but inappropriate at 3 AM when the morning team will be there in a few hours. It is EXTREMELY rare that a pt needs a stat suppository.
+ If I call you because the kids BP is High or Low, don't ask if I am sure! Yes I am sure! And NO I don't need to change the cuff -- it's the same correct cuff I have been using all shift, and probably all week. I need you to get up and come see the pt like I asked you to.
I cant just take your word for it without at least asking. I have no idea whether you've been doing this job for 30 years or 30 days. I've seen lots of nurses who are using the wrong sized cuff, especially in peds, so thats why I ask about it. Its a common occurrence to use a mismatched size cuff. Agreed about seeing kids that are going south.
+ If I need to call the Attending or Fellow, it's not a slap in your face - I need to do what's best for my patient. We're all here to learn and you need to leave your big ego at home.
Thats fine, as long as you tell me first. Its unacceptable to just call them without keeping me in the loop. Explain why you want to call them and dont be overly rude about it. I understand that there are cases where you need to go above the intern's head.
+ No, I cannot take EVERY order as a verbal order - it is not safe. There is a Resident and a Senior for a reason.
I dont understand what verbal orders have to do with upper level residents. If I write a written/electronic order instead of verbal, then it doesnt make any difference in terms of who is supervising me. The only way my upper level knows about it is if you or I page them. I agree that verbal orders should be used sparingly.
+ You cannot have the chart for 2 hours.
Fair enough. Its ridiculous in this day and age to have written charts anyways.
+ Don't call me at midnight and ask me where the pt's I/O's from the day shift are - really not my problem. I already asked Suzie Sunshine...she didn't think it was important to get them in the computer I guess, or maybe the kid is shutting down['/quote]
I think you should at least make an attempt to look into it. I realize you arent responsible for what other nurses do or dont do, but just tell me that instead of saying "its not my problem." Each ward has its own unique features which are nightmares for interns, and by pointing us in the right direction its better for patient care. For example, I've seen wards where they keep written summaries of the Is/Os in a locked cabinet in case it doesnt get entered into the computer. If thats the case, then give me a freakin clue that I can look for them in there. I'm not asking you to go to medical records and pull the whole file, just give me a pointer about where I might be able to look. If you really dont know, then thats fine, just say something like "it appears that the prior nurse never entered any Is/Os for this patient."
the best I can do is have you come up and talk to the patient or call that cute nurse your were swooning at change of shift at home (you seemed like you might want her phone number).
Upper levels and fellows do this a lot more than interns do, trust me we are too busy for that BS.
+Don't call me at 10 or 11 pm when I am passing out my meds to ask where my first set of vitals and the I/O's are: look, we don't have a tech and I am taking care of a fresh transplant and 2 other patients. When I can humanly get them in the computer, I will. And don't tell me you need them so you can "go to dinner" or "pick up your take out"....hmm, I might not get them in there for quite some time. If you really need to know how the kid with the new kidney is doing, come see them!!!
Fair enough, just give me an ETA. I dont know how busy you are or what your schedule is. If you dont have it right now just tell me to check back in 30 mins, hour, etc.
+ If you MUST talk to me when I am on my precious lunch break of 20 minutes trying to cram in whatever food I can, you better not be calling about something stupid that "I can help you with"
Stupid phone calls/pages go both ways. Each unit and each nurse usually has separate lunch hours, so its kinda hard for us to have all the schedules memorized. Just give me a little friendly guidance and I'll oblige you. But we'd also like you to return the favor and not page us at 4 AM because some guy hasnt had a bowel movement in the last 24 hours.
Most of the problems with intern/nurse communication occurs because both sides are overworked and stressed out, lack of sleep, etc. I agree that interns can be rude and thats totally unacceptable. But I also think that nurses should have a different threshold for what deserves a page at 4 AM compared to 4 PM.
I will allow trebugRN to reply to most of this post. I am slightly enlightened and slightly enraged. Apparently you have worked with a wide variety of nurses and intuitively do not trust us. I find that sad. We/nurses were asked for tips to new interns: how to get along with the nurse. I feel we have provided a fairly comprehensive list. I think perhaps the "take what applies and remember the rest" approach here might be helpful.
Specializes in Psychiatric, Detox/Rehab, Geriatrics.
first of all if that doctor wants to refer to themselves as "doctor smith", they most certainly can, no matter what there age is. they worked hard to earn that title and can use it how ever they see fit as according to law. doctors are doctors because they went to school for that, just like we as nurses went to school to be nurses, and can refer to ourselves as "nurse smith" if we want to. some people need to come down off of there pedestals, yes you may be an experienced nurse, but you are not a doctor. doctors should respect nurses, and vice versa. i don't see how someone saying there name is "doctor smith" is irritating or disrespectful when that person earned that title.
i taught an acls class this afternoon, and all the participants were 4th year medical students. they're scared and excited about being real doctors in a few months! one of the topics that came up was how to be on good terms with the nurses. i came up with a few ideas right off the top of my head, but what do you guys think? what would you tell them?
the first few things i thought of were:
don't ever tell a nurse your first name is "doctor." your mother gave you a first name, and although i have known a few mds with the last name of "docter", i haven't ever met anyone with a first name of "docter." and nothing irritates an experienced nurse more than being asked to call some kid 30 years younger than herself "doctor smith." i'm likely to say "then you can call me "mrs. vee." you don't want that.
when you come to see my patient, tell me who you are. and don't ever tell me "i'm his doctor." we have a lot of those in most hospitals. are you the psych consult, the cardiologist who admitted him, or the nephrology resident coming by to evaluate him for dialysis? it would be nice of you to say "hi, i'm althea. i'm the pulmonology resident here for a consult."
bring us chocolate. we like chocolate!
so what would you guys like to tell the new residents who come to work with us?
First of all if that doctor wants to refer to themselves as "Doctor Smith", they most certainly can, no matter what there age is. They worked hard to earn that title and can use it how ever they see fit as according to law. Doctors are doctors because they went to school for that, just like we as nurses went to school to be nurses, and can refer to ourselves as "Nurse Smith" if we want to. Some people need to come down off of there pedestals, yes you may be an experienced NURSE, but you are not a Doctor. Doctors should respect nurses, and vice versa. I don't see how someone saying there name is "Doctor Smith" is irritating or disrespectful when that person earned that title.
I agree,why the doctors shoudnt be allowed to call themselves just that,since this is who they are....
I really like it when doctors on rounds ask if there are any nursing concerns before moving on to the next patient.
I really try to avoid interrupting an intern/student on rounds presenting and wait until the discussion for plans for medical treatment start before stating my concerns, but sometimes I feel the docs don't give me a chance to speak unless I interrupt.
Asking about nursing concerns can save an intern calls and pages later.
All I ask is this -- don't just breeze in, write a few orders and a sloppy note I can't read and say NOTHING to me -- try checking in a bit with me -- the nurse who is with the pt. for an entire 12 hrs. Let me know your thoughts, your plans, the plan of care -- TEACH me something from your viewpoint. It really will result in better care for the patient and will maximize MY efficiency. However, do remember I have other patients I'm caring for as well.
We are all supposed to be a team, and I'd like to be treated as a team member. I am supposed to know EVERYTHING about this patient -- but it's hard when I can't read anyone's writing and things are going badly and you haven't checked in lately and it's almost 7 p.m. Just COMMUNICATE, politely. No need for chocolate from me . . . just good communication and politeness.
I happen to love most interns and residents, though -- it's some of the attendings that I take issue with. Most docs are great, though -- just a few bad apples here and there.
When I tell you that the patient is on 60mg/hr of versed and he is still awake, I expect you to listen to me when I say that versed doesn't do crap for someone with alcohol withdrawl. If it did, it would be included on the ciwa protocol along with valium/ativan but it isn't. If you do not listen to me, I will call your senior and see what he thinks about the patient's sedation situation.
did this thread all of a sudden morph from a nursing vent thread to a doctor's excuse thread?
i appreciate this sentiment, but it should be used sparingly during late night hours. this is an appropriate page at 5 pm, but inappropriate at 3 am when the morning team will be there in a few hours. it is extremely rare that a pt needs a stat suppository.
i cant just take your word for it without at least asking. i have no idea whether you've been doing this job for 30 years or 30 days. i've seen lots of nurses who are using the wrong sized cuff, especially in peds, so thats why i ask about it. its a common occurrence to use a mismatched size cuff. agreed about seeing kids that are going south.
thats fine, as long as you tell me first. its unacceptable to just call them without keeping me in the loop. explain why you want to call them and dont be overly rude about it. i understand that there are cases where you need to go above the intern's head.
i dont understand what verbal orders have to do with upper level residents. if i write a written/electronic order instead of verbal, then it doesnt make any difference in terms of who is supervising me. the only way my upper level knows about it is if you or i page them. i agree that verbal orders should be used sparingly.
fair enough. its ridiculous in this day and age to have written charts anyways.
+ don't call me at midnight and ask me where the pt's i/o's from the day shift are - really not my problem. i already asked suzie sunshine...she didn't think it was important to get them in the computer i guess, or maybe the kid is shutting down
i think you should at least make an attempt to look into it. i realize you arent responsible for what other nurses do or dont do, but just tell me that instead of saying "its not my problem." each ward has its own unique features which are nightmares for interns, and by pointing us in the right direction its better for patient care. for example, i've seen wards where they keep written summaries of the is/os in a locked cabinet in case it doesnt get entered into the computer. if thats the case, then give me a freakin clue that i can look for them in there. i'm not asking you to go to medical records and pull the whole file, just give me a pointer about where i might be able to look. if you really dont know, then thats fine, just say something like "it appears that the prior nurse never entered any is/os for this patient."
upper levels and fellows do this a lot more than interns do, trust me we are too busy for that bs.
fair enough, just give me an eta. i dont know how busy you are or what your schedule is. if you dont have it right now just tell me to check back in 30 mins, hour, etc.
stupid phone calls/pages go both ways. each unit and each nurse usually has separate lunch hours, so its kinda hard for us to have all the schedules memorized. just give me a little friendly guidance and i'll oblige you. but we'd also like you to return the favor and not page us at 4 am because some guy hasnt had a bowel movement in the last 24 hours.
most of the problems with intern/nurse communication occurs because both sides are overworked and stressed out, lack of sleep, etc. i agree that interns can be rude and thats totally unacceptable. but i also think that nurses should have a different threshold for what deserves a page at 4 am compared to 4 pm.
netglow, ASN, RN
4,412 Posts
ROFL Canoe! I busted out laughing when I read this... (pump button) :pntlft: