As an Intern,Resident,how did you learn to be assertive with hospital staff?

[Hoody]

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Ah, but therein lies the rub. It's actually not my job.

If your name is on the on call list for the night and I need an order clairified, yes, it is your job. If you disagree, talk to the person who made the call list (your boss)

You have to realize that there's a huge disconnect between what the nurses jobs are and what the overnight resident's job is.

Lucky for me, I dont have to call the resident. We call the attendings. Thank god they realized that they are in a profession where they are going to be called in the middle of the night.

At most places the overnight intern/resident is carrying multiple pagers, covering many patients who are not his own. His job is to keep all the patients alive and not in excessive pain throughout the night, to make sure all the labs got ordered, to follow-up on a handful of things the day team couldn't get done and signed out to him, and to make sure patients get whatever bowel preps and hydration and stopping of anti-coagulation meds, etc such that they can get whatever procedure they are scheduled for in the morning. And that's it.

Sounds like they are "on call." Sounds like if I need an order clarified, they are the on to call. Gee, sounds like a job.

They are hugely overworked just to accomplish those tasks most nights. And by orders of the attendings, chiefs, etc, that is all the nighttime shift ought to be doing.

Awww, poor overworked residents. boo hoo. I rarely (as in never) get to eat lunch, or pee, during my 12 hour shifts in the ICU. And I really dont paid a whole lot more than you. Boo hoo. Life is hard. Nurses are hugely overworked too.

The nurses, by contrast, tend to have a lot less to do once their patients go to sleep,

you mean there are very few physicians around at night so the nurse has to do more at their own digression. yeah, thats what I though you meant. At night in the ICU, we dont even have a doctor. The ER doctor comes and intubates and we take orders over the phone from the intinsivist attending. Gee, we have so much less to do at night, thanks for pointing that out.

so the nursing administration, in its infinite wisdom, has decided that that's the perfect time for them to do a chart review.

Its not designated for a certain time, it just has to be done once every 24 hours. Maybe you should bitch to the medicine crew, in their infinite wisdom, that they made a call schedule and put you on it. Dont they know that disrupts your precious sleep, dont they know that you are hugely overworked? how rude!

Perhaps if you guys did you OWN chart review, we wouldnt have to call you to clairify silly orders at 3am. No, no, we will delegate that out, make someone else review our orders and then bitch at them when they call during my beauty sleep. Light bulb?

That may be protocol, but it's protocol for nurses, not for the doctors. It is NOT "by law". Sorry, but if they told you that, they lied.

Policies at my facility = the law. Dont follow them and you get fired. Thats the same for every facility and also applies to you residents. If you stray from hospital policy, its not gonna be fun. Maybe you should experiment? Or maybe you should just quit giving me a hard time for doing what my facility mandates (i.e. my job)?

The better nurses save the issues that don't have to be addressed that night for a morning call. The less keyed in ones make multiple calls throughout the night.

The better residents make sure to physically circle and or mark which protocol/standing orders you are to use throughout the night. Which resident are you?

But don't get confused -- while you may feel it's your job to make those calls, it is often NOT the poor SOB on the other side of the line's job to attend to those calls.

tear.

 

[Hoody]

actually, TexasPhysician and LawtoDoc, I have a better idea for you...

next time a nurse calls you in the middle of the night for something that you don't feel is legit, just tell them, "Thats not my job"

Then in the morning, when nurses report to each other and/or round with the attending, she can pass along that she called you in the night for something and you told her/him that it was "not your job".

Lets see how well that goes over. Perhaps the attending will clarify whose job it is. 🙂


Respect is something you get when you give it. Try respecting your nurses and you may just get a little respect back (shocker!!!!!11!!). And rather than bitch and whine on an anonymous internet forum about how crappy nurses are, you could educate the nurses (respectfully) that keep disrupting your beauty sleep. That might help change their "annoying and unnecessary" habits (shocker again!!!111!!one!!!eleventy!!!11).

 

[StudyShy]

Then don't assume you should take the "veteran" nurse's advice over that of the "green intern."


They're more experienced in some things, but not in others. The experienced surgical floor nurses often know less about the operating room than the med students.


I have a pretty good relationship with most nurses. The key is to take their concerns seriously and to let them know what is important with a given patient. Sometimes, if you explain why the patient needs a certain treatment, you'll get a lot less resistance to implementing it. Also, I get plenty of calls at inappropriate hours of the night asking for really mundane things. If you politely say, "Thanks for pointing that out. Why don't you leave a note for the primary team on the chart so they see it in the morning?" then they stop calling for that sort of thing.

👍


Hopefully these stupid phone calls are just the nurses covering their butts and not for things like, "I will talk to their daughter tomorrow why are you telling me now about the daughter wanting to talk to me?"

Unfortunately, nurses still have to call for minor even OTC things such as Tylenol if there is no standing order for one. Nurses dread calling physicians in the middle of the night because they do not want to get their head chewed off, but most rather play it safe than sorry.

Nurses shouldn't be rude. I've seen my share of them. Likewise, I've seen rude things from physicians. However, in both cases, it seems like impoliteness happened during a particularily stressful time when on both sides, people were not thinking clearly.

I feel badly about the patients most of all. They get the brunt of the physicians and the nurses.

 

[Perrotfish]

Policies at my facility = the law. Dont follow them and you get fired. Thats the same for every facility and also applies to you residents. If you stray from hospital policy, its not gonna be fun. Maybe you should experiment? Or maybe you should just quit giving me a hard time for doing what my facility mandates (i.e. my job)?

I think you're missing the point. Nursing and Medical chains of command don't really talk to one another anymore and don't have a common supervisor that's even remotely accessible, so the Doctor can't get fired for ignoring nursing protocols anymore than a nurse can be fired for not following our protocols. He's not experimenting, it's really not his resposibility. The entire problem is that the rules that you're following aren't 'the law' for anyone but nursing. This is the problem with having no one in charge: it creates a strong incentive to have combative relationships because there's no more diplomatic process in place to resolve interdepartmental conflicts.

 

[Hoody]

I think you're missing the point. Nursing and Medical chains of command don't really talk to one another anymore and don't have a common supervisor that's even remotely accessible, so the Doctor can't get fired for ignoring nursing protocols anymore than a nurse can be fired for not following our protocols. He's not experimenting, it's really not his resposibility. The entire problem is that the rules that you're following aren't 'the law' for anyone but nursing. This is the problem with having no one in charge: it creates a strong incentive to have combative relationships because there's no more diplomatic process in place to resolve interdepartmental conflicts.

perhaps your right, but thats no excuse to treat floor nurses like ****.

**** for not talking care of a patient, **** for trying to take care of the patient. Perhaps we should just get the hell out of the way and let the resident do everything?

Lastly, my shift is 7pm-7am. When I call the provider, I'm not thinking about his day, or his sleep, I'm thinking about the patient. I don't see it as a night/day thing, I see it as a shift thing. To me, 7p-7a is the day.

 

[Wilf]

Too bad it's not like it was 20-30 years ago when doctors wouldn't get in trouble for how they treated subordinates unless it was truly something egregious. The thought of having to deal with nurses like hoody and not being able to say anything because the egalitarian movement has even infiltrated medicine is hard to take.

That being said, the way I see some surgeons treat nurses makes me think that the hierarchy might still be in place. I sure hope so.

 

[Perrotfish]

perhaps your right, but thats no excuse to treat floor nurses like ****.

Can you think of a more effective solution? I hate to say it, but if the calls stop coming when you're rude and they keep coming when you're nice then being polite and helpful is really enabling a policy that is incredibly dangerous for the patient. The on call Intern does not (for example) need to be screwing with the Cardiology patient's heart medication at 3 a.m. just because that's when chart review happens to be. If that results in the nurse being made miserable I see the nurse as a victim of their superiors who made up the idiotic rules rather than the physician who refuses to follow them. If you were in the doctor's shoes, and it was apparent that the nursing staff had no intention of altering their protocols no matter what the physicians said, what would you do?

 

[TexasPhysician]

Just as there are good doctors and bad doctors.

If your name is on the on call list and I need to call about something, then YES, IT IS YOUR JOB TO ANSWER THE PHONE, LISTEN TO MY QUESTION, AND GIVE ME SOME DIRECTION. Don't like that? Go cry to your attending. As a nurse, I don't deserve to be treated like **** for doing my job just because it interferes with your sleep and you don't like it. Grow up. Or change professions.

Saying that nurses have less to do at night is idiotic. please, go back to doctoring, you know nothing when it comes to nursing.

oh, and yay for teamwork. Its a good thing we (doctors and nurses) are in this together, eh? Sometimes you have to wonder how patients get better at all....

Agreed that there are good doctors and bad doctors. I already mentioned this above. I'm not sure why the nurses are getting all upset. I complain about poor doctors as well - we can talk about that too if you like.

I get along great with 99% of all nurses. I appreciate a majority of the calls I get while on call. Why must you get all upset about a litte debate?

Some nurses just call WAY too often because they lack a good knowledge base. Some doctors come to me too often because of a POOR knowledge base.

When did I say nurses have less to do at night?

I'm confused.😕

 

[Hoody]

Can you think of a more effective solution?

Yes. I already posted several.

I hate to say it, but if the calls stop coming when you're rude and they keep coming when you're nice then being polite and helpful is really enabling a policy that is incredibly dangerous for the patient.

You must have missed my post where I said it would be far more effective for these two to try and respectfully educate the nurses who are constantly bothering them?

Bitching on this forum and to continuing to treat all nurses with such attitude will definitely change things! 👍

The on call Intern does not need to be screwing with the Cardiology patient's heart medication at 3 a.m. just because that's when chart review happens to be.

Yes, because thats all we ever call for....

If you were in the doctor's shoes, and it was apparent that the nursing staff had no intention of altering their protocols no matter what the physicians said, what would you do?

I'd do my job as my facility mandates. I'm not in administration, I'm a nurse. I really don't have a problem calling the doctor at 3am because in his infinite wisdom, he didn't clarify his standing orders. Perhaps you guys should start paying closer attention to your work...or like I already mentioned, do your own daily chart checks. Or rather than get mad at the nurse, call after call, get mad at the doctor that wrote the ridic order (light bulb!)


Nurses recognize the good doctors and take care of them. Perhaps you guys should try hard to be the good doctors after residency and you can avoid most of this ****. Or continue to be the whiny, ineffective babies you've been on this thread and the nurses will reciprocate. What goes around, comes around. You make the choice.

 

[Hoody]

When did I say nurses have less to do at night?

I'm confused.😕

You didn't. In my fit of rage I thought you had.

My bad.

 

[Hoody]

I get along great with 99% of all nurses. I appreciate a majority of the calls I get while on call. Why must you get all upset about a litte debate?

Some nurses just call WAY too often because they lack a good knowledge base. Some doctors come to me too often because of a POOR knowledge base.

I've seen some doctors limit the number of calls nurses can make.

Lol, I'm sure this type of **** only flies at the VA (cause our government is totally ghetto), but during the weekend, the VA lets basically anyone with a pulse moonlight.

We have one guy who only lets a certain nurse call him three times a shift. She has to figure out how to consolidate all her **** into three calls.

I'm not sure what happens with the fourth call....I'm guessing his neck veins pop.

I feel your pain. I know the nurses you speak of. What bothers me is that when nervous nellie nurse over here calls you 8 times for bull**** stuff and then I call you once because dude no longer has a pulse in his left foot and you treat me with the same disdain you treat the other nurse. Treatment should not be equal.

If I were you guys, I'd complain to nursing administration about these types of nurses. I cant speak for all facilities, but doctors still have a say around here and my administration would listen and try to help.

 

[TexasPhysician]

actually, TexasPhysician and LawtoDoc, I have a better idea for you...

next time a nurse calls you in the middle of the night for something that you don't feel is legit, just tell them, "Thats not my job"

Then in the morning, when nurses report to each other and/or round with the attending, she can pass along that she called you in the night for something and you told her/him that it was "not your job".

Lets see how well that goes over. Perhaps the attending will clarify whose job it is. 🙂

I have told the nurses that it "isn't my job" or something similar. Faculty backs me up. I'm not going to adjust a specialist's medication choice at 3am unless it is an emergency. If the Dilantin level comes back at 6pm and it is 1 point over normal, don't let me know at 3am. These are just some possibilities. Again, most nurses do NOT do this. They understand the medication, who prescribed it, and how emergent the situation is. I appreciate that in my nursing staff. I believe that my nursing staff is excellent. We get along very well and they know what to do in almost any situation. An intelligent nursing staff is priceless. A poor nursing staff will kill you. Just like fellow physicians in a group practice.

I try not to be rude at all times with any medical provider. I'm not always polite, and this is especially true in emergent situations.

 

[TexasPhysician]

I've seen some doctors limit the number of calls nurses can make.

Lol, I'm sure this type of **** only flies at the VA (cause our government is totally ghetto), but during the weekend, the VA lets basically anyone with a pulse moonlight.

We have one guy who only lets a certain nurse call him three times a shift. She has to figure out how to consolidate all her **** into three calls.

I'm not sure what happens with the fourth call....I'm guessing his neck veins pop.

I feel your pain. I know the nurses you speak of. What bothers me is that when nervous nellie nurse over here calls you 8 times for bull**** stuff and then I call you once because dude no longer has a pulse in his left foot and you treat me with the same disdain you treat the other nurse. Treatment should not be equal.

If I were you guys, I'd complain to nursing administration about these types of nurses. I cant speak for all facilities, but doctors still have a say around here and my administration would listen and try to help.

I feel your pain. After so many hours in a row, many physicians (and almost anyone for that matter) will lose their temper. I dread waking up an attending if I'm stumped, so I know what you mean.

I try to give each caller a fair shot (physician or nurse or anyone else) in the middle of the night. Blow your shot, and I have no problem asking your name to talk about things later. I actually think that has worked well for me. Some nurses know that if they ask a "stupid" question in the middle of the night, I might give them a lecture over adverse reactions to Ativan or whatever the next day - politely of course.

I love teaching......just not at 3am.

I know with typing on a forum, not everything comes out as PC as I would like. I respect nurses in general 100%

 

[Hoody]

I'm not always polite, and this is especially true in emergent situations. Being rude sometimes just gets the job accomplished more efficiently.

Agreed.

Two nights ago, I had a first year resident order (over the phone) 6L for a patient with low BP (60s/30s) because she had "no expereince with vassopressors." If said resident were standing in front of me, I would have gotten a drug guide and thrown it at her head. Instead, I slammed the phone down and called the intinsivist attending and told him what said resident just ordered. It solved that problem really fast. I never bothered to relay new orders back to resdient because the patient obviously wasn't a priority of hers.

As long as you are cool with nurses being rude to you, then I suppose its cool that you are rude to them. You know what they say, two wrongs make a right. 😉

 

[Signifier]

Do any of you guys go into work and think, "Hey, I'm a prick" with a smile on your face?

 

[Hoody]

Do any of you guys go into work and think, "Hey, I'm a prick" with a smile on your face?

No. But when I'm a doctor I might. 😳

Everything we are venting in her is just part of the job. And honestly, if Law2Doc could change things, he probably would. I am giving him a hard time because I myself am having a hard time at work lately. It just comes with the game.

One of my patients needed a swan early this morning (at that magical time, 3am) and the doctor was like, "come closer to me, I won't bite you, I promise." This is the same doctor who threw a pair or hemostats across the room just two days earlier in his own little tissy. Its a mind game, but medicine is.

The worst part is that hardly any patients care about themselves or their health (unless they are acutely dying). We sit here and argue about this stuff and put waaaaaaaaaaaaaay more work into taking care of the patient than they put into taking care of themselves. kinda irritating too. bleh. what the hell is going on in medicine!?!

 

[Holderlin]

you guys are talking about basic aspects of human interaction.

only on SDN.

 

[45408]

Just as there are good doctors and bad doctors.

If your name is on the on call list and I need to call about something, then YES, IT IS YOUR JOB TO ANSWER THE PHONE, LISTEN TO MY QUESTION, AND GIVE ME SOME DIRECTION. Don't like that? Go cry to your attending. As a nurse, I don't deserve to be treated like **** for doing my job just because it interferes with your sleep and you don't like it. Grow up. Or change professions.

Saying that nurses have less to do at night is idiotic. please, go back to doctoring, you know nothing when it comes to nursing.

oh, and yay for teamwork. Its a good thing we (doctors and nurses) are in this together, eh? Sometimes you have to wonder how patients get better at all....

You're just going to keep hearing: "I'll leave that up to the primary team to decide that in the morning."

Floor/OR/PACU nurses do have less to do at night for each patient, which is why the day nurses have 3-4 patients on the floor and the night nurses have 7-8 patients. My wife liked working nights because they were much quieter and less busy. The ER is different, and the ICU is about the same.

actually, TexasPhysician and LawtoDoc, I have a better idea for you...

next time a nurse calls you in the middle of the night for something that you don't feel is legit, just tell them, "Thats not my job"

Then in the morning, when nurses report to each other and/or round with the attending, she can pass along that she called you in the night for something and you told her/him that it was "not your job".

Lets see how well that goes over. Perhaps the attending will clarify whose job it is. 🙂


Respect is something you get when you give it. Try respecting your nurses and you may just get a little respect back (shocker!!!!!11!!). And rather than bitch and whine on an anonymous internet forum about how crappy nurses are, you could educate the nurses (respectfully) that keep disrupting your beauty sleep. That might help change their "annoying and unnecessary" habits (shocker again!!!111!!one!!!eleventy!!!11).

They would gladly tell you that it is the primary team's job, not the cross-coverage.

Take some of your own advice and be a little more respectful here for a change.

 

[45408]

Yes, because thats all we ever call for....

Obviously not, but that's what we're asking that nurses NOT call us for.

I'd do my job as my facility mandates. I'm not in administration, I'm a nurse. I really don't have a problem calling the doctor at 3am because in his infinite wisdom, he didn't clarify his standing orders. Perhaps you guys should start paying closer attention to your work...or like I already mentioned, do your own daily chart checks.

You still can't grasp the concept of cross-coverage. They're not my chart checks, because they're not my day-time patients.

Nurses recognize the good doctors and take care of them. Perhaps you guys should try hard to be the good doctors after residency and you can avoid most of this ****. Or continue to be the whiny, ineffective babies you've been on this thread and the nurses will reciprocate. What goes around, comes around. You make the choice.

Ironic.

 

[gettheleadout]

ITT: Premed argues with residents about the responsibilities of residents.

 

[Hoody]

Take some of your own advice and be a little more respectful here for a change.

you show very little respect for nurses, so no, I probably won't show very much respect for you.

You still can't grasp the concept of cross-coverage. They're not my chart checks, because they're not my day-time patients.

They aren't my day-time patients either.

who else could we pass the buck to?

Ironic.

Indeed.

 

[Hoody]

ITT: Premed argues with residents about the responsibilities of residents.

but resident can argue with nurse about nurse responsibilities with any more validity?

fail.

 

[gettheleadout]

you show very little respect for nurses, so no, I probably won't show very much respect for you.

They aren't my day-time patients either.

who else could we pass the buck to?

Indeed.

Maybe the doctor that they do belong to?

 

[gettheleadout]

but resident can argue with nurse about nurse responsibilities with any more validity?

fail.

Well they're the senior care provider so...

^ I know that answer is oversimplified but TheProwler's point is that you're not following how the system is structured with regard to a resident's responsibility overnight.

 

[Perrotfish]

They aren't my day-time patients either.

who else could we pass the buck to?
.

If you can't tell the difference between the night nurse and the cross covering intern that's pretty bad.

As the night nurse you work the same number of hours and the same number of shifts as the day nurse. You have the same level of training as the day nurse and you are no less familiar with the patients than the day nurse is. That's why your responsibilities are approximately the same as the day nurse, and you can't leave the non emergent stuff nursing for the next team to handle.

The Intern is cross covering. He is 12 hours in to a 30 hours shift. He is taking care of more patients than any attending would ever manage as a primary provider, and he met most of them at the start of the shift. He is less than one year in to his residency training. He is too tired, busy, unfamiliar with the patients, and undertrained to manage medication regimines that were put into place by well rested specialists who have 3 years of residency training and 5 years of fellowship training. That's why everything that isn't life threatening tonight waits for the primary team in the morning, which is exactly how the system is supposed to work.

BTW in this thread you have repeatedly looked down on the idea that the Intern on call should want or expect to sleep. It was honestly pretty condescending stuff: 'sorry to interupt your beauty sleep', 'if you don't like it pick a different career', etc. The call system was very specifically designed with the idea that physicians would be on 'call', as in call them if absolutely necessary but otherwise leave them alone. It's amazing how no other professional in the hospital can respect that, or even acknowledge the difference between working nonstop for 12 hours (which attending physicians do all the time with few complaints) and for 30 hours. Just so you know, this 'suck it up' attitude from nurses who have never dreamed of working a triple shift of their own has basically killed the call system: Starting next year Interns can only spend 16 hours in the hospital at a time, and I'm sure the other residents will have the same rules soon enough. On the plus side, that will solve a lot of your problems with physician rudeness since the inevitable night float system won't involve anyone expecting to sleep during their shift. However, when the hospital has to hire night float attendings to replace the residents I dread the commisurate budget cuts.

 

[45408]

you show very little respect for nurses, so no, I probably won't show very much respect for you.

Ugh, please, I'd love for you to show me in this thread where I've demonstrated "very little respect for nurses." I've repeatedly said that it's only a small minority of nurses that I've worked with who do this, and even for relatively important things but not that time sensitive, the nurses will usually try to cluster calls together to limit their pages.

They aren't my day-time patients either.

who else could we pass the buck to?

"I'll leave that up to the primary team to decide that in the morning."

 

[Law2Doc]

...
Its not designated for a certain time, it just has to be done once every 24 hours. ...

Um, that's kind of my point. There are about 16 of those 24 hours where the person on the other end of the pager might actually be able to help you, but the system is foolishly set up on the nurses side to defeat this. The daytime team writes the orders, but for whatever reason, the rocket scientists in nursing administration decide that 2am, when everybody who actually participated in the patient's care plan is long gone, is somehow the perfect time to start doing chart review and calling and asking questions/clarifications. It's bad for patient care but more important it often borders on malpractice for me to try and recreate a plan, at 3am, on a patient I'm cross covering and never saw before that night. It's simply indefensible, and I'm not exactly sure why you are defending it.

But I reassert that the overnight call person has a specific set of tasks that are his job. This isn't one of them. You can bitch all you want that "blah blah blah" its the law "blah blah blah" you are the one with their name on the pager "blah blah blah" but at the end of the night the overnight call doc only has to answer to his attendings and his chiefs, and to his malpractice carrier, not to the bodies that govern nurses at the hospital. The night folks have very clear charging orders. They have their own "it's the law" protocol and dealing with things that don't have to be dealt with that night is simply not on it.

FWIW, I've never slept during an overnight call, because the places I've worked spread the overnight folks too thin. So you are never waking me from beauty sleep, just more important patient care tasks. Don't kid yourself that you are equally busy -- if you were that busy, they wouldn't have decided your shift was the one during which they should do the 24 hour chart review. Your shift got picked because you have down time. But not everyone in the hospital has your life of leisure.

As I said before, the good nurses get this, and do what they can to group questions and limit their questions to things that involve patient care THAT NIGHT. The not so good nurses jump on the phone a dozen times a night for inane things that could have waited until the next day, if not forever, and fall behind "its the law" rhetoric.

 

[TexasPhysician]

Agreed.

Two nights ago, I had a first year resident order (over the phone) 6L for a patient with low BP (60s/30s) because she had "no expereince with vassopressors." If said resident were standing in front of me, I would have gotten a drug guide and thrown it at her head. Instead, I slammed the phone down and called the intinsivist attending and told him what said resident just ordered. It solved that problem really fast. 😉

Good play. Like I said, in an emergent situation you don't have time to fix stupid. The resident should have asked your opinion or called an attending.

 

[NYRN]

If that is how the nurse felt, I'd tell them to give me the needle and get out of the way. Then I'd write them up and talk to administration about their poor judgement. In a dangerous situation, you don't have time to sit the nurse, med student, fellow physician, etc. down and explain pathophysiology. Otherwise I am very respectful to everyone. Even received numerous awards for it. I'm just unwilling to compromise patient safety to give someone a lecture.

As a resident on numerous rotations, you don't have time to develop months worth of respect. Maybe you only have a few days. If the nurse/physician/whatever doesn't think what I do is safe, they can be my guest to discuss it with my faculty.

Nurses have every right and in fact legal duty to question any order that they believe to be dangerous or incorrect. If you are barking orders at me that I believe are incorrect/dangerous, I will ignore your temper tantrum and go right to your attending who will be standing right there if this is in fact an emergency situation and take orders from him/her. We are all human, and ANYONE under pressure can make a mistake in a tense situation. If you think you are above making a mistake, than think again. In addition to all of this, in my hospital we are not allowed to take verbal orders from residents or PA's in my hospital with the exception of ACLS measures, which an attending would be present for anyway.

The best way for an intern/resident to be treated with respect is to treat others with respect, plain and simple. Every July you will have residents/interns who will come up to the nurses/techs/clerks, introduce him/herself and kindly ask us about the way things work here and what they would like us to do. We will go out of our way to help those that help us and who are nice to us. The A hole interns/residents who have a god complex are going to have a long 3+ years here..

 

[TexasPhysician]

Nurses have every right and in fact legal duty to question any order that they believe to be dangerous or incorrect. If you are barking orders at me that I believe are incorrect/dangerous, I will ignore your temper tantrum and go right to your attending who will be standing right there if this is in fact an emergency situation and take orders from him/her. We are all human, and ANYONE under pressure can make a mistake in a tense situation. If you think you are above making a mistake, than think again. In addition to all of this, in my hospital we are not allowed to take verbal orders from residents or PA's in my hospital with the exception of ACLS measures, which an attending would be present for anyway.

The best way for an intern/resident to be treated with respect is to treat others with respect, plain and simple. Every July you will have residents/interns who will come up to the nurses/techs/clerks, introduce him/herself and kindly ask us about the way things work here and what they would like us to do. We will go out of our way to help those that help us and who are nice to us. The A hole interns/residents who have a god complex are going to have a long 3+ years here..

I would tell you to feel free to contact my faculty as they are usually not attached to my hip. In the meantime, I'd write a progress note explaining the date/time of my order and the delay in nursing staff to administer said order. It's my behind too. Thankfully nursing staff and I have not had this conversation because we work things out respectfully and quickly.

I'm not saying I can't make a mistake, but the few times nursing staff has disagreed with me has been laughable. Quality nurses will assess risk and only disagree if they are 100% sure it would cause harm - very respectable and appreciated. Others will try to change my orders to something they just feel more comfortable with - that is unacceptable. A lack of knowledge is not reason to disagree with my order. I can't fix stupid while patients suffer. Now if you have a legit reason why my actions will be harmful or inappropriate - I appreciate your criticism.

At all of the hospitals I have worked at in my career, all verbal orders are allowed.

 

[orthomyxo]

ITT: everybody's getting mad

 

[TexasPhysician]

ITT: everybody's getting mad

We have gotten quite a bit off track. As the OP can tell, many medical professionals have quite a bit of assertiveness, me included. 🙂 A lack of assertiveness can often lead people to think that you do not know your stuff.

It is important to know when to speak your mind, when to take control, and when to just be kind to everyone around you. Hopefully much more on the kind side.

Interestingly enough, the only time I have been reprimanded by administration is for sneaking desserts out of the doctor's lounge for nursing staff. Apparently that is "against policy and is too costly for the hospital" 😡 Well worth it in my opinion.

 

[officedepot]

In life, you'll get this everywhere. You just have to deal with it until it's all over. If you're at the bottom of the totem pole, voicing yourself could harm you, as they'd do whatever in their power to keep you at the bottom. If you are higher in title than the one disrespecting you, then that's on you. There's no way in hell that I'd let some nurse talk to me poorly if I am a doctor (resident, attending, intern..). There's just NO WAY! I don't want to be discouraging, but if a person is not assertive by college-age/end of college career, it's going to be difficult making any huge changes at that point. Is assertiveness essential for being a great doctor? Probably. But not all docs are great....but they're docs!

you clearly have no experience with work and especially in a hospital. You have to be respectful no matter what. Being assertive is not the same thing as being rude and a jerk with a massive ego. Nurses are very important and you should value their opinion and judgement (e.g. they are around the patient a lot more than any doctor in the hospital). People like you though will learn the hard way when you are put in your place and find out no one likes to work with you. As a intern you know nothing. Even as chief resident when you know stuff you still can't be an ahole to those you work with. If you're nice they will be as well.

 

[Tabicakes]

perhaps your right, but thats no excuse to treat floor nurses like ****.

**** for not talking care of a patient, **** for trying to take care of the patient. Perhaps we should just get the hell out of the way and let the resident do everything?

Lastly, my shift is 7pm-7am. When I call the provider, I'm not thinking about his day, or his sleep, I'm thinking about the patient. I don't see it as a night/day thing, I see it as a shift thing. To me, 7p-7a is the day.

You seem like a very angry person ..

 

[SouthernSurgeon]

I have told the nurses that it "isn't my job" or something similar. Faculty backs me up.

Exactly.

I have answered pages this way many times. If it is an unreasonable request, I politely say "this is a non-urgent issue that can be addressed by the primary team in the morning." end of conversation.

Agreed.

Two nights ago, I had a first year resident order (over the phone) 6L for a patient with low BP (60s/30s) because she had "no expereince with vassopressors." If said resident were standing in front of me, I would have gotten a drug guide and thrown it at her head. Instead, I slammed the phone down and called the intinsivist attending and told him what said resident just ordered. It solved that problem really fast. I never bothered to relay new orders back to resdient because the patient obviously wasn't a priority of hers.

As long as you are cool with nurses being rude to you, then I suppose its cool that you are rude to them. You know what they say, two wrongs make a right. 😉

Your posts on this thread show a clear disconnect, and it sounds like you work in an at least semi-private practice environment, or at least that you deal with attendings more often than most nurses. Do you have any idea how much the surgical floor nurses at my hospital would get chewed out if they called an attending in the middle of the night?

Your lack of respect for interns is obvious, and really doesn't provide any positive contribution to this thread. Guess what...some of us do in fact know what we are talking about on occasion.

I also like that you are calling out the intern who is married to a nurse as having no respect for the profession...

We are talking only about the extremely unnecessary pages here, and all of the residents have freely acknowledged that the vast majority of our interactions with nurses are positive. Why are you taking this as an assault against your profession?

 

[LizzyM]

Some of the posts here cause me to recall that health professionals as a group are relatively unsuccessful at gaining admission to medical school. It may not be that adcoms don't want to poach from another profession but that some of these folks have a chip on their shoulder and aren't team players.

 

[SouthernSurgeon]

Going back to the original poster's question...

Everyone develops a different style; some more effective than others. As this thread demonstrates, there can be an unfortunately antagonistic relationship between the residents and other health professionals. I will freely admit to having days where I feel like everyone in the hospital is trying to sabotage me. I remember one rotation where I was in a different hospital than usual...there is this really nice glass-walled stairwell and I frequently fantasized about how satisfying it would be to throw my pager down it...

But in terms of how I personally am assertive with staff? A few things. Number one is that I think I am actually pretty good at my job at this point, and I am comfortable responding to the vast majority of patient problems. It is easier to be assertive when you feel confident in your decision-making. Additionally, nurses and others notice this. When they physically see you in the room assessing the patient, when you can explain your decisions to them rationally, when you don't make stupid choices, they take you seriously. Number two is that I stay calm. I don't raise my voice, I don't yell, I don't run around looking frantic. Number three is that I expect others to know what they are talking about. If you page me in the middle of the night with a clinical concern, you better have the patient's full set of vitals, you better be able to tell me when they got their last meds, etc, etc.

 

[Perrotfish]

Some of the posts here cause me to recall that health professionals as a group are relatively unsuccessful at gaining admission to medical school. It may not be that adcoms don't want to poach from another profession but that some of these folks have a chip on their shoulder and aren't team players.

To be fair, I really don't think that team metaphor has ever worked very well for healthcare as a whole. If you've ever been on a team, whether for sports, the military, or in the corporate world, you'll know that teams have leadership. Someone has to be the coach/captain, or the team concept doesn't work.

The nurses you probably think of as 'not team players' probably, by and large, are excellent team players. The problem is that their 'team' is nursing. If you watch them interacting with their own colleages I think you'll see that they're defferential to their supperiors, compassionate towards their co-workers, and show real leadership towards new memebers of the team. However they don't answer to us, we don't answer to them, and the shadowy hospital beurocracy that we both theoretically answer to isn't available to resolve most of the day to day disputes. That give tems every practical reason to focus on satisfying their own administration (which has the power to reward them in real and tangible ways) and to ignore the anoyance of physicians (which carries few consequences)

 

[LizzyM]

To be fair, I really don't think that team metaphor has ever worked very well for healthcare as a whole. If you've ever been on a team, whether for sports, the military, or in the corporate world, you'll know that teams have leadership. Someone has to be the coach/captain, or the team concept doesn't work.

The nurses you probably think of as 'not team players' probably, by and large, are excellent team players. The problem is that their 'team' is nursing.

That's my point. They don't recognize that the team is the patient care team. They think of themselves on a team against another team and that plays out as an "us v. them" attitude toward people with whom they need to work cooperatively. The result is snotty, mouthy, condescending attitudes that take a lot of effort to un-do. Frankly, some adcoms would rather take a chance with career changer from finance or teaching, or an inexperienced undergrad than take in a member of the health care team who is going to be hell on wheels to the nurses she left behind.

 

[Perrotfish]

That's my point. They don't recognize that the team is the patient care team. They think of themselves on a team against another team and that plays out as an "us v. them" attitude toward people with whom they need to work cooperatively. The result is snotty, mouthy, condescending attitudes that take a lot of effort to un-do. Frankly, some adcoms would rather take a chance with career changer from finance or teaching, or an inexperienced undergrad than take in a member of the health care team who is going to be hell on wheels to the nurses she left behind.

I guess my point was that there doesn't seem to be anyone in the hospital who really thinks of themselves on the 'patient care' team, which is reasonable because that team doesn't actually appear to exist. It seems like each service in the hospital instead thinks of themselves as their own team trying to protect their colleagues and their patients from the other submorons that populate the hospital. Whether you're Surgery, General Medicine, Psych, a subspecialist, Nursing, PT/OT, Respiratory care, EMS, Social Services, or Nutrition chances are you think of yourself as a memeber of your own small tribe within the hosptial and you think very little of everyone else. The single most consistent thing I've seen across all my rotations has been the condescending 'us vs. them' attitude that each medical profession seems to have towards every other medical profession, including physicians towards any physician that went through a different residency. The physician leadership plays up the team concept at conferences and offical functions of course (as does the nursing leadership) but the recurring theame of every breakroom conversation is always how every other services is full of lazy, self centered f- ups. Since none of the medical services have common chains of command there is, once again, no one who objectively resolves these disputes and disciplines the people causing them. Since no one except the patient suffers from the rude, obstructionist physicians, and since what tangible rewards there are favor being rude and obstructionist (you do less work for the same pay, the other people on your service like you for pushing back against everyone elses stupid policies) interdepartmental conflicts continue perpetually. There's nothing wrong with nursing other than the fact that they're not the exception to the rule.

If it were me on the ADCOM I would actually favor someone who had developed a snotty, mouthy, condescending attitude from nursing, because I think that when they then began to develop the same snotty, mouthy attitude biased towards their new medical career the ingrained habit of being condescending in the other direction might actually balance them out into being a moderately decent person to work with. Ultimately, of course, I'm hoping to go back to having a central command structure within the hospitals so that there is someone who has the authority to resolve dozens of different protocols and schedules. That might take awhile, though.

 

[Moosecakes]

. Good one.

No, its not some random attending. And yes, they do notice.

Cool story, bra, but orders are generally not clarified very well. So yeah, by law, I'm supposed to call you and get such clairified (no matter the time). If Im doing a 24 hour chart check at 2am and I cannot read your chicken scratch writing about NG's to gravity or suction, you are most definitley getting a call. Give me attitide and I will probably turn you in to the supervisor. 🙂


Its your job. do it.

Have you really made nearly 3000 posts in less than 2 years?
Wow. 😱

 

[MossPoh]

I didn't read a lot of the stuff; mostly because it was too long. There is a difference between being "assertive" and being a bossy condescending a-hole. You can be assertive AND respectful. For the most part, I've always done the kill them with kindness technique. Assertiveness is a skill learned before residency for many people. Some haven't refined it yet, but it is still there. Value their time, as well as your own. Obviously, if they are notorious for not doing ANYTHING then the dynamic changes. Overall, just be nice to people. Help them out once in a while. Build up a little credit. Don't be condescending. When you truly need something, most people will know you really do need it done and they are more likely to help you out. Also, even if it is something simple they did, you thank them. Being appreciative and courteous to others goes a long way and then those off days you have just become an outlier.

As your knowledge base grows you also become increasingly aware of what is best for the patient, which translates to it being easier to say what you want done. It is tough to be assertive when you know less than other people.

 

[Duluth]

That's my point. They don't recognize that the team is the patient care team. They think of themselves on a team against another team and that plays out as an "us v. them" attitude toward people with whom they need to work cooperatively. The result is snotty, mouthy, condescending attitudes that take a lot of effort to un-do. Frankly, some adcoms would rather take a chance with career changer from finance or teaching, or an inexperienced undergrad than take in a member of the health care team who is going to be hell on wheels to the nurses she left behind.

This seems to be a rather narrow minded view. It would be better to look at individuals interactions with members of the health care team rather than painting an entire profession as a problem. Or perhaps you believe nurses should be subservient and serve physicians rather than serving the patient. There are nurses who don't play nice with others just as there are physicians.

 

[Law2Doc]

This seems to be a rather narrow minded view. It would be better to look at individuals interactions with members of the health care team rather than painting an entire profession as a problem. Or perhaps you believe nurses should be subservient and serve physicians rather than serving the patient. There are nurses who don't play nice with others just as there are physicians.

I don't think many people on here are arguing that nurses should be subservient. I think people on here are suggesting that the better nurses (and there are quite a few out there) should be cognizant of the fact that the physician teams during the daytime hours are the ones who make up the patient care plan, and so bothering someone during the wee hours of the night who isn't on that team (the bulk of your patients at night are cross coverage) to ask him to decipher or recreate an order that doesn't even have to be implemented until the next morning, is a waste of two people's time, and probably sets the hospital up for a big medmal case that could be avoided if the nurse simply saved the question for the dude who wrote the order and who will show up in 4 hours anyhow.

In that respect the residents responding on this thread are really hoping to empower the nurses to use some restraint and common sense (and again, many do), rather than take an "it's the law" or "it's protocol" attitude and call somebody and tell them to "do your job" even though it seems clear from this thread that s/he has no clue what the overnight resident's job actually is.

When you are the overnight person doing a 30 hour shift you have a very clear, very limited set of tasks to accomplish because odds are that one of the three pagers you are carrying will be going off ever half hour or so. You really don't have time to deal with chart review at that time, you aren't supposed to deal with chart review at that time (per YOUR bosses), and are supposed to limit your activities to things that are necessary to get your list of patients through the night in good shape, not too much pain, and with whatever preparation is necessary for any morning procedures they might have. And that's it. That's my job. Ask any of MY bosses and they will tell you that is all they want me to do. They will get annoyed if I take time out of these duties to deal with chart review or other things that don't need to be taken care of for THAT night's patient care.

Now if you have a question about an order I wrote, by all means call me. If the patient is due some treatment that night that you have an honest question about (ie "I can't tell if you wrote for 1.5 mg of morphine or 15"), then that's absolutely fair game - page me. Or if the patient is becoming hypoxic, tachycardic, bradycardic, very febrile, limbs are turning blue, abdomen's getting rigid, excruciating pain, then by all means call me. If the patient is vomiting or urinating blood, call me. You are my eyes and ears on the floor as I have three teams worth of patients I'm covering, and I need you to let me know when something's not right. For a lot of the other stuff that comes up in the chart review, though, the morning is the appropriate time to ask. All the stuff I didn't list above is more than likely not going to be my job. It might be your job to relay the question, but not to me. Understand that there is a conflict in the system -- the hospital requires you to audit the charts and call someone, but the person you have the ability to call has been given a totally different set of charging orders. It's not his job. He's simply the poor sap holding the pager of the person for whom it is the job -- the morning guy. But I promise you that just as you feel you will get in trouble not relaying these questions, the overnight resident will get in as much trouble with HIS bosses by spending too much time dealing with you and these questions instead of his actual charging orders. There will be nights when you are running around just to make sure everyone is staying alive. You don't have time to worry about poor penmanship making it hard to determine whether someone is allowed 1 gas-ex every 6 hours or every 8, when the dude is asleep and not asking for medicine anyhow.

 

[SouthernSurgeon]

In that respect the residents responding on this thread are really hoping to empower the nurses to use some restraint and common sense (and again, many do), rather than take an "it's the law" or "it's protocol" attitude and call somebody and tell them to "do your job" even though it seems clear from this thread that s/he has no clue what the overnight resident's job actually is.

Exactly.

When you are the overnight person doing a 30 hour shift you have a very clear, very limited set of tasks to accomplish because odds are that one of the three pagers you are carrying will be going off ever half hour or so. You really don't have time to deal with chart review at that time, you aren't supposed to deal with chart review at that time (per YOUR bosses), and are supposed to limit your activities to things that are necessary to get your list of patients through the night in good shape, not too much pain, and with whatever preparation is necessary for any morning procedures they might have. And that's it. That's my job. Ask any of MY bosses and they will tell you that is all they want me to do. They will get annoyed if I take time out of these duties to deal with chart review or other things that don't need to be taken care of for THAT night's patient care.

I would actually get INTO trouble if I went around re-writing or changing orders on cross-cover patients overnight. Like you said - the cross covering intern at night is not the one making the plan, nor should they be. The job overnight is triage and management of acute clinical problems.

 

[Streicher]

lol, this thread is good!

And it reminds me of how the field of medicine attracts certain types of people.

It is tough taking people seriously when they spend so much time discussing the social dynamics of their work.

I judge them to be less intelligent. It has been my experience that the smartest people care about the science and stay out of the whole social drama nonsense.

I know for a fact that some doctors do this. But the fact that so many don't says a lot about the people who populate the field!

 

[Duluth]

Exactly. The job overnight is triage and management of acute clinical problems. .

No disagreement here. What wards are you guys having all these problems with nonemergent pages from? Nurses should use some common sense when paging.

 

[SouthernSurgeon]

No disagreement here. What wards are you guys having all these problems with nonemergent pages from? Nurses should use some common sense when paging.

Again I would emphasize that the vast majority of my interactions with nurses have been positive. But at some point it just becomes an issue of volume...if you are cross-covering for 40 patients at night and there are a few nurses who just "dont get it"...it adds up.

 

[Law2Doc]

... It has been my experience that the smartest people care about the science and stay out of the whole social drama nonsense.

I know for a fact that some doctors do this. But the fact that so many don't says a lot about the people who populate the field!

Um, you will learn that medicine is not about science (at least not 95% of it). And you sure won't be doing/learning a lot of science as the overnight resident. If you are going into medicine to purely be a scientist, you picked your field badly. I think some of the emphasis on science prereqs confuses a lot of people who think that this is a scientific field like being a chemist or biologist might be. In fact, the profession is squarely anchored in human drama. You will do far more counseling, advising, breaking bad news, getting people to open up and confide in you, and teamwork issues than science in most clinical specialties. You will have a handful of drugs you use, but in most cases the biochemical principles behind them will be far less important in your practice than convincing the patient he actually has to take them, or in dealing with a social worker to find a way for him to pay for them. So get ready to embrace the drama. The social drama is a BIG part of this field.

 

[Streicher]

Um, you will learn that medicine is not about science (at least not 95% of it). And you sure won't be doing/learning a lot of science as the overnight resident. If you are going into medicine to purely be a scientist, you picked your field badly. I think some of the emphasis on science prereqs confuses a lot of people who think that this is a scientific field like being a chemist or biologist might be. In fact, the profession is squarely anchored in human drama. You will do far more counseling, advising, breaking bad news, getting people to open up and confide in you, and teamwork issues than science in most clinical specialties. You will have a handful of drugs you use, but in most cases the biochemical principles behind them will be far less important in your practice than convincing the patient he actually has to take them, or in dealing with a social worker to find a way for him to pay for them. So get ready to embrace the drama. The social drama is a BIG part of this field.

I chose medicine because I want to do something useful.

I know medicine is a very very soft science. BUT, maybe the way you view medicine is different from how others do.

The surgeons I shadowed seemed narrowly interested in the surgery and I had the pleasure of listening to them debate with each other on how to do things. I liked that!