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Hey the pre-meds are doing it. I'll take some tips before mid June.
(1) Be polite to everybody, regardless of the time of night. And especially in the Emergency Department.
(2) If you just put an order on a chart, it helps speed up the process to actually tell the nurse that you did so. And they often appreciate the heads up coming from you personally.
(3) Call consultants personally. They will greatly appreciate hearing from you instead of some random nurse, and will likely personally call you back with what you need to know. Plus, as the previous poster noted, it helps expedite the process and ultimately gets your patient out the door faster.
(4) Be on time more often than not.
(5) Be enthusiastic and have a sense of humor. It's a hard job and most people appreciate a little levity and genuine interest.
(6) Don't sign out ridiculous and non-essential labs and tests to your co-interns.
(7) Never lie. The interns who try this on rounds are not exactly inspiring confidence from their colleagues. And it looks completely idiotic when an attending or nurse rips the facade away.
(8) Oh, and I can't remember but I think there was something about not doing harm written down somewhere or other. To me, this translates into "knowing your limits." Don't be afraid to ask, and don't be afraid to err on the side of looking dumber in the interest of patient safety.
(9) Take care of yourself so that you can care for others. Spend time with your wife, read books, work out, watch movies, go out to dinner, spend time on your hobbies, drink lots of scotch, or whatever. Just find some way of being able to decompress...you're gonna need it.
Good luck.
That in IM, it's more important to get the morning work done than to get your progress note in the chart by morning work rounds. And that you save a LOT of time by NOT returning repeatedly to different charts, but simply work your way through the hospital floor by floor once in the morning (pre-rounds) and once more in the afternoon.
Instead of writing each note one by one, just grab a blank progress note from each patient's chart, swing by their room and write down just their vitals and overnight events (and their meds, if you have time). Collect all of the notes. Then, right before work rounds, sit down at a computer and write down all the patients' labs on their progress notes.
Then do work rounds and write orders in the chart (if your hospital has written orders).
During noon conference or other downtime, you can then take out your pile of progress notes and finish all of them within a half hour.
After lunch when you have free time to work, swing by each patient's chart to drop off the progress note. While you're there, write any additional orders and call consults.
When your last progress note is out of your hands, you are DONE and ready to sign out while your colleagues are still running around.
Does your attending not frown on the fact that your "note" is entered in the chart after his? Seems like there's little for you to learn and you've already got the given plan handed to you (if you didn't already have it yourself) from your rounds with the team. Seems like you should have a note prior to rounds.
I would actually have attendings stand in the hall while you wrote your note if it wasn't complete by the time we were rounding - usually 0700 - 0730. Nothing quite so nerve-wracking as having your attending tapping his feet as he (and the entire team) waits for you to complete your note so he can basically put his "saw patient on rounds and discussed with Dr. so-and-so. Agree with his/her note and plan." 4am really sucked that month!
jd
Does your attending not frown on the fact that your "note" is entered in the chart after his? Seems like there's little for you to learn and you've already got the given plan handed to you (if you didn't already have it yourself) from your rounds with the team. Seems like you should have a note prior to rounds.
Does your attending not frown on the fact that your "note" is entered in the chart after his? Seems like there's little for you to learn and you've already got the given plan handed to you (if you didn't already have it yourself) from your rounds with the team. Seems like you should have a note prior to rounds.
1. Don't argue w/ nurses, unless it's patient care that's involved. They are not worth it. It's like arguing with a 7 year old. You have better things to do, and talking to a nurse just drains about 10 brain cells per minute.
You lose 100 brain cells for your "new" concept
Time OUT
Everyone is worth your time to debate any issue...Get over yourself
We're not worthy
Nurses have been valued since waaaaay before you were born...
We value your opinion...Take a look at ours...
It's (shhhhhockingly) about the patient, not you and your ego...
good luck in your endeavors...
We'll be there to explain away your shortcomings
Educationally speaking, I'm not worthy...I get that...
Wow, insecure much? Jeez. And, no, I don't think EVERYONE is worth my time to debate things.
1. Don't argue w/ nurses, unless it's patient care that's involved. They are not worth it. It's like arguing with a 7 year old. You have better things to do, and talking to a nurse just drains about 10 brain cells per minute.
hey chimi? could you maybe... not do this in this thread? I agree with you, but you're really mucking up a great thread with some BS that has its place elsewhere. thx.
Anyone have some examples, esp PRN stuff? My brain has been wasting away s/p match, please help soon to be clueless intern out.How to write effective sliding scales for insulin, potassium, etc. and how to write effective and comprehensive PRN orders.
You're kidding right?
Chimi was simply responding to some very insulting comments about her colleagues and has every right to do so, especially in the fashion in which she has done so (many of her colleagues would not have done so). IMHO, she wasn't trying to derail the thread, only responding to the rude and inappropriate comments herewith - where else would you suggest she respond?
You're kidding right?
Chimi was simply responding to some very insulting comments about her colleagues and has every right to do so, especially in the fashion in which she has done so (many of her colleagues would not have done so). IMHO, she wasn't trying to derail the thread, only responding to the rude and inappropriate comments herewith - where else would you suggest she respond?
JCAHO is getting crappier and crappier about orders so check with your seniors about what's allowed at your house but here are some good starters:Anyone have some examples, esp PRN stuff? My brain has been wasting away s/p match, please help soon to be clueless intern out.
Many nurses are clueless and dumb. Sorry for pointing that out.
Now, in the ICU things are different and I think many ICU nurses could actually run the unit without any housestaff. But on the floors, I wouldn't trust 75% of them.
Nope! Was just reading the thread beginning to end and it was FANTASTIC up until one child came into another child's playbox and they both started throwing sand. I suggest they start a thread about egocentric residents vs overworked nurses and go from there. Thanks for your SUPER moderation, as always!!!
rude and inappropriate?
I call a spade a spade
Many nurses are clueless and dumb. Sorry for pointing that out.
A dumb doctor probably still has more medical knowledge than the average nurse. As an incoming intern, I was sometimes intimidated by the suggestions of nurses who seemed to know what they were talking about and would go along with whatever they said. Later I realized, that for every time they are right, they are wrong the other half. Go with your guts and do what you think is right.
Now, in the ICU things are different and I think many ICU nurses could actually run the unit without any housestaff. But on the floors, I wouldn't trust 75% of them.
JCAHO is getting crappier and crappier about orders so check with your seniors about what's allowed at your house but here are some good starters:
Insulin slide:
FSBS q 6 hours or qac and qhs
if glucose < 70 give 1/2 amp D50 po or iv and recheck FSBS in 30 min
if glu 70 - 150 do nothing
if glu 151 - 200 give 2 units reg insulin SQ
" 201 - 250 " 4 "
" 251 - 300 " 6 "
" 301 - 350 " 8 "
" 351 - 400 " 10 "
" >400 " 12 " and call MD
Potassium slide:
If K < 3.0 call MD
If K 3.0 - 3.2 give K riders x 40 meq iv over 4 hours or KDur 40 meg po
If K 3.2 - 3.3 " x 30 meq
If K 3.3 - 3.5 " x 20 meq
If K > 6.0 call MD
Tylenol:
Tylenol 650 mg po/pr q 4 hours PRN pain/fever
*only do the fever part if you expect the patient to have a fever and you don't need to work it up
*remember to provide alternate routes. If the pt can't take it po it's gotta go pr. This goes for other stuff too. You don't want a call a 0200 to ask if the IV ativen could be given PO.
Fever:
If Temp > 100.6 obtain blood cx x 2, urine cx, sputum cx, CXR.
Pain:
Morphine 1-5 mg IV q 4 hours PRN pain
Dilaudid 1-2 mg IV q 4 hours PRN pain
Antiemetics:
Phenergan 12.5 - 25 mg IV q 6 hours PRN nausea
*write it as nausea because they technically can only give it after the patient pukes if you write "vomiting."
Resp:
Albuterol 2.5 mg Neb q 4 hours PRN wheezing
Atrovent 0.5 mg neb q 8 hours PRN wheezing
*write wheezing instead of SOB or they may keep giving Nebs to your worsening CHF patient.
Sleep:
Restoril 15 mg po qhs PRN sleeplessness
*every oldster expects a sleeper. Your covering colleagues or night float will love you if you write for the sleepers.
Anxiety:
Ativan 1 mg IV/IM/PO q 6 hours PRN agitation
Haldol 2.5 mg IV/IM/PO q 6 hours PRN agitation
*be stingy on this one. The idea is to deal with the demented sundowner patients without over sedating a patient with unrecognized delerium.
Vent:
ABG PRN vent changes
You don't want a call at 0200 asking if it's OK to get the gas just so you can get called 30 min later with the results.
Disclaimer: I'm sure there are those who want to debate dosages and so on and maybe even the use of slides and PRN altogether. Instead of doing that I'll just say that you have to use judgement and know your patients. You have to base these things on your particular patient and your labs norms.