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?
Remember, if you treat me like a "stupid nurse" I will be more than happy to play "stupid nurse" all night long and call you with every "stupid" question I might have regarding "your" patients. Respect is a two way street.
Don't be offended when we put electronic security bands on our neonatal/pediatric stethoscopes on the pediatric unit. We only have so many peds stethoscopes and are not in a situation to be able to order several every week that you walk out with. If it's banded, you WILL shut down the unit and the alarms WILL be blaring when you try to leave (ie: elevator will not close/open, doors to the stairways will lock, access doors lock. We will be more than happy to retrieve it from you in the elevator with our patient who is being discharged and no we will not apologize for the inconvenience. Even better, bring it to us yourself.
Remember, if you treat me like a "stupid nurse" I will be more than happy to play "stupid nurse" all night long and call you with every "stupid" question I might have regarding "your" patients. Respect is a two way street.
Don't be offended when we put electronic security bands on our neonatal/pediatric stethoscopes on the pediatric unit. We only have so many peds stethoscopes and are not in a situation to be able to order several every week that you walk out with. If it's banded, you WILL shut down the unit and the alarms WILL be blaring when you try to leave (ie: elevator will not close/open, doors to the stairways will lock, access doors lock. We will be more than happy to retrieve it from you in the elevator with our patient who is being discharged and no we will not apologize for the inconvenience. Even better, bring it to us yourself.
If I am in a pt's room when you enter please don't ask me to leave, maybe I need to be able to reiterate what you tell them after you leave since I can't read your writing most of the time. 99% of the time the patient is going to ask me what you meant by such and such anyway!
Oh and do me a favor.....if you write a stat order don't put the chart back in the rack...
When you see a closed door KNOCK for God's sake. I may be doing something like cathing or bathing someone and they would appreciate the privacy.
When you leave when you see I am doing such then CLOSE the door don't leave it wide open. How would you like it?
When you hear the vent alarm going off then check it out. Don't stand at the bedside and do nothing. There were 2 residents and an intern in that room, and not one of them checked to see what was alarming. I had to go over from the otherside of the unit to see what was going on. The pt bipab was disconnected and her mask was on but she wasn't getting any oxygen.
Unfortunately you have missed what I believe is the entire point of this thread. This is a common occurrence with young, eager and very well or not so well prepared new Dr's.
You are not "reading between the lines" for the true meaning of our information and assertions here. This thread and many others like it are meant for your edification. Not amusement. But it is clear from your responses that you refuse to take advise/information from those nurses who would endeavor to make your education more meaningful, less stressful and safer for your patients and your license and ours.
Doctor, this thread is aimed directly at you. Please take off your brand new white lab coat and learn.
It is not often you will find wisdom like that which is being offered here all in one place.
Re: Tips for New Interns: How To Get Along With The Nurse
Originally Posted by trebugRN
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.
For a pt going through active ETOH withdrawal..... Please 0.5mg of Ativan is a spit in the wind...the pt may be calm when you walk into the room, but when we say "pt a" has been kicking, climbing out of bed etc.. we are not making this up. If you don't believe us you sit with the pt for 12 hours and hope someone is free for 2 minutes so you can go to the bathroom. Also I agree just a quick introduction ...I am Dr. so and so and I am here for a consult. Check before eating the food in the fridge..sometimes the kitchen send just enough for the pts..it may be their evening snack if they are a diabetic. If you don't know where supplies are please ask for assistance don't tell us to go get it. We have a job to do as well. Try not to interupt us while we are passing meds and never interupt us when we are counting narcotics (big no no). And finally...try to remember we are all here for the patient and although you have a higher education as a doctor..kudos to you..it does not make you a more superior individual. I just want what is best for my patient and yours. Thank you!
IF I call you at 3 in the morning, I didn't mean to. I don't spend all night shift going I'm going to call Dr so and so at 3 am just so he can yell at me.
Its important, I need your help, I call everyone else at the hospital and no one could help me out.
Also if they are here they are most likely in pain, ORDER PAIN MEDICATIONS. Don't wait till they are yelling in pain for me to call you, order it and then wait for pharm to come up with it. Then chew me up for waiting so long to give it to them. That leads to the next one: the brush off. If I said it, it means it was important enough for me to tell you. If I said he is going to be in pain, he most likely will be in pain. I've been with him for 12 freakin hours I KNOW what a big baby he is.
Please leave detailed instructions. call me if there are any problems isn't going to help.
Specializes in Telemetry, Oncology, Progressive Care.
If I make a suggestion to you - you know the obvious and I make the lightbulb in your head go off do not take all the credit for it. I can't help it that between the medical student, intern, resident, np, and attending plus numerous consults you didn't think to order an obvious med.
Would it really be that hard to talk with the nurses and let them know what the goals of care are for a patient. It's kind of difficult when you are doing your thing and I am doing my thing and really don't have a clue what the plan of care is. I have found most interns and residents to be nice to work with. I learn from them and they learn from me.
I could care less about the chocolate or any food that you might want to bring. I do care about being treated with respect. Just remember I can inundate you with useless text pages if you find it necessary to be an ass. I can do the same.
Do not touch the pumps!!!!!!!!!!!!!!!!!!!!!! If you give me an order to turn off a diltiazem gtt because the pt bp is not tolerating it - DO NOT turn it back on.
If I tell you it's not ok to change a discharge order after I've signed off on it then that does not give you the right to harrass me about every little thing for the rest of the month. I'm sorry but what you did was very illegal. It's ok to change an order. Just write a new order. Oh and don't start scratching things off in the chart. A line is good. Scribbling is for babies.
Do not tell me "because I'm the Dr and I said so," when I ask for clarification on an order, or when I ask a question so I can explain something to my patients. I will not be happy and you will need me to do something for you some day - if you can find me then.
Also, I will and do advocate for my patients. If this is a problem for you, maybe you should think about getting into administration instead of being someone that is supposed to help patients get well.
How about this one--Dear Doctor, clean up your messes. Or at least try to confine the mess to the trash can or a disposible towel so I don't risk needle sticks and other unsavory things when I go behind you to clean up blood & body fluids that you have flung to the four corners of the room. Did your mother not teach you to clean up after yourself? You are not too special to put things where they belong. I am not your servant.
Best intern I ever worked with had been an ER nurse first. He was so respectful to the nurses. Always cleaned up his stuff, didn't expect nurses to run around trying to please him, and he ALWAYS kept sight of his sharps and disposed of them himself. Bravo!
Of course, for every one great intern there were at least 5 jerks who had exactly 4 days experience with neonates who wanted me to enact their poorly written orders and go to bat with attendings when they got it wrong. Really? I'm sorry, love ya and everything, but I'm not losing my license for this. I didn't go to med school, you did. I don't need to have to watch you like a hawk so you don't accidently kill one of these premies. If you have questions about doctoring, best you should ask your resident or the attending.
Mar 29, 2009, 01:40 AM 
Re: Tips for New Interns: How To Get Along With The Nurse
starfire33
3 Posts
Good heavens, just TALK TO ME!
Let me know whats going on! Or if I'm unavailable, write something legible in the progress notes!
Heck, just write legibly period!
If I do something wrong, point it out! If you have a sec, teach me why you are doing something,
if one doctor did that once a day imagine how many less phone calls and bothering on site I would
have to do!