being kind to interns??

[telenurse]

New month, new year, new rotations...

The other night had a new resident I wasn't familiar with...very nice guy, I think he's new to the hospital.
The hospital has been crazy all week, we're discharging and then admitting pt's before the antiseptic's even dry on the bed.
This resident as finishing up admits, and was bouncing from floor to floor, as soon as he'd sit down his pager would go off, and off he'd go running back to the other floor...and his upper level was riding his butt too.
All our floors look exactly alike, and at one point, he even looked around and forgot which floor he was on.
I was working a 12, had taken 4 admits early on, and was thoroughly caught up, and so I took pity on the poor fellow, and discreetly went behind him and was preprinting heparin, insulin, and other order sheets and clipping them to the front of charts as reminders and placing them at "his" computer. Then when he came back pointed him at the coffee, told him to take a couple of deep breaths, slow down, gather his thoughts, then get on with it. I told him "you'll get through this, and you will learn to be faster and more efficient, it's trial by fire"

So...when I get a poor frazzled intern who is being overwhelmed...what are things that I as a somewhat experienced RN who is familiar with the policies, procedures, and normal ordering practices and preferences of my floor/specialty can do to assist and encourage?

(Don't accuse me of flirting by the way...I used to tutor years ago in college...and it kills me to see people struggling...it's probably one of the reasons I have a more nursing focus than medical, I sort of enjoy teaching hands on type of stuff... I love teaching the nursing students IV's, foleys, NG tubes, head to toe assessments, etc.)

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[Blade28]

Then when he came back pointed him at the coffee, told him to take a couple of deep breaths, slow down, gather his thoughts, then get on with it. I told him "you'll get through this, and you will learn to be faster and more efficient, it's trial by fire"

So...when I get a poor frazzled intern who is being overwhelmed...what are things that I as a somewhat experienced RN who is familiar with the policies, procedures, and normal ordering practices and preferences of my floor/specialty can do to assist and encourage?

Another reason why you have my vote as the coolest nurse on SDN.

I think you did everything you could to help him out. Just the simple act of being supportive (despite him getting slammed) and offering coffee for him really helps more than you'd think. I think the best anyone can do in that situation is to understand how busy he is, not page him or harass him when he can't come right away to write admission orders, and just in general be more patient with him.

I applaud your support of the overworked intern/resident!

 

[Nataliemay24]

Don't accuse me of flirting by the way...

Okay. But there's nothing like feeling attractive to make one's day better and one's confidence soar.

 

[SoCuteMD]

Honestly, please don't let Tired speak for us all. As a med student a year and a half away from internship I GREATLY appreciate any pizza/coffee/speed donations while on call!

 

[Ypo.]

Hey Telenurse; all those things sound great. Thanks for your efforts. I know I really appreciate it when a nurse shares their knowledge with me.

 

[Faebinder]

Tele.. you are such a cool nurse that I would love to have you around where I battle.

On the other hand, making an intern life simple is deceptively easy but such a foreign concept to many people on the wards. The list of "What I wish my nurse would do" is in the general residency forum now. The list is very nice and comprehensive.

The biggest issue for an intern is the pager. The pager is evil. Minimize being evil by minimizing pages. Did you see the poll that tells you a person gets paged over a 100 times per day at times? Yes... minimize pages.

 

[fab4fan]

Bad tempers are a two way street.

A few months we were having the day from hell. The resident needed something ASAP; unfortunately, what he deeded he wasn't going to get immed. because it required calling a doc's office, geting records faxed over, yada, yada. In between all that, I got several fresh post-ops. It wasn't his fault the info wasn't on the chart and it wasnt mine--this should have been addressed in PAT.

He kept approaching me about the paperwork and my answer was always the
same: You'll get it when you get it. I was really starting to get behind the 8-ball, and exasperated about the whole situation. At one point I remember getting somewhat curt with him. I hated that, because he is usually very easy to work with.

After the dust settled from the situation, I took him aside and apologized for my rudeness, and that having too much going on was not an approrpiatereason to be short -tempered. He was very nice about it and sad he'd meant to talk to me about his being frustrated and that although it seemed that way, it wasn't directed at me personally. I think we both found a new-admiration for each other.

Peace and harmony have been restored again.

 

[chimichanga]

Which is good, but why didn't he just make the damn call himself?

Then you would have posted here about the lazy nurse...

no winning with you

 

[telenurse]

I don't really need people "being kind" to me. Many seem to view interns as some kind caught-in-the-headlights neophyte deserving of either pity or scorn. What I actually am is a professional, trying to do a hard job as well as I can.

I don't want to be friends with other people in the hospital. I don't want to get invited to nurse parties. I don't want coffee. I don't want a pat on the back or the head. I want vitals done, meds given, and events reported.

The best thing any nurse can do for me is to do their job, with a minimal amount of complaining coming in my direction.

it's not pity the poor puppy who's drowning because he hasn't figured out how to doggie paddle yet...

BUT if I know that this or that standard order form is required and not filled out, or the pt is on home cpap, or the pt is on metformin but may be going for an angiogram....having a cpap or sliding scale insulin form on the front of the chart is beyond my duties as a nurse...but may be helpful to the resident and may save him/her unneccessary pages and buttkicking from his/her upper level.

Also this serves pt care...because it establishes a rapport...if the resident knows that I can assess these things early on...we can develop a working relationship and a working trust. Which then comes in handy at 0230 when I call for stat lactic acid level because something just "not right with this pt, and I know his WBC's have been up all week, but now he's AMS and has borderline low UOP, and his temp is 95.3"

It also serves me in a purely selfish way...I find that the nicer I am to MD's as interns, the more likely they are to teach me as they become upper level residents...I love to learn, if I wasn't a nurse, I would have been a professional student.

 

[telenurse]

Another thing I want to know is, there are certain things it seems the residents and interns aren't sure of...the unwritten rules...

1.no am lovenox if you think pt is going to cardiac cath lab, pm lovenox ok
2.angiomax is ok on floor for HIT pts, not used often but it's ok
3.never, never, never give plavix precath!!!!! Bill Clinton effect if pt needs CABG! our cardiac team will throw a fit.
4.NEVER EVER give Dr. XYZ's pt blood unless HGB less than 6.8, SERIOUSLY! (even if he's not Dr. XYZ's pt, if XYZ has operated on pt in past 6 month, don't give it!!)
etc, etc
Resident's on cardiac service know this, but when we get pt's on family med or internal med with ACS on the floor with the cardiac consult...that's when the nurses start looking at each other out of the corner of our eyes and mumbling, "holding lovenox and plavix until consult is over".

Do the specialties ever tell the residents these little preferences??

 

[bryanboling5]

I think it's great that you are nice to the interns. From my nursing school clinicals and working in 2 different hospitals, I've seen 2 "typical" ways nurses treat docs. In the private hospital where (almost) everyone is an attending (except the occasional resident doing a community rotation). They are generally nice to the docs and the docs are GENERALLY nice back. There are a few who are jerks. Then, I went to work at a teaching hospital and found out why some docs might treat nurses like crap...at the teaching hospital. the nurses by and large treated the interns and residents like garbage.

The difference was they could get away with it. No one talked to attendings that way. They could beat up on the residents and get away with it. In turn, once those residents are out in the private practice world, they can get some revenge by turning the tables on nurses.

Is that juvenile? Sure. But I think you can see why it happens.

Now, I'm not saying that's the only reason that some docs act like jerks, but I'm sure it contributes. I've never understood why more people don't understand that if you treat someone with respect, you make YOUR life a lot easier!
Bryan

 

[bryanboling5]

I'm just saying that "personal rapport" is no substitute for professional respect. And I wasn't trying to apply this you, I swear. Just recent annoyances that prompted my last post.

That is an excellent point! The personal rapport is great, but if you're not doing your job, it doesn't matter. My comments were predicated on the assumption that the nurse was actually working. That's a bad assumption, unfortunately...
Bryan

 

[sophiejane]

I don't really need people "being kind" to me. Many seem to view interns as some kind caught-in-the-headlights neophyte deserving of either pity or scorn. What I actually am is a professional, trying to do a hard job as well as I can.

I don't want to be friends with other people in the hospital. I don't want to get invited to nurse parties. I don't want coffee. I don't want a pat on the back or the head. I want vitals done, meds given, and events reported.

The best thing any nurse can do for me is to do their job, with a minimal amount of complaining coming in my direction.

I believe it's possible to actually exchange a kind word with the other people involved in patient care, act like a well-mannered and congenial human, AND get things done for patients in a professional way.

 

[Samoa]

Another thing I want to know is, there are certain things it seems the residents and interns aren't sure of...the unwritten rules...

1.no am lovenox if you think pt is going to cardiac cath lab, pm lovenox ok
2.angiomax is ok on floor for HIT pts, not used often but it's ok
3.never, never, never give plavix precath!!!!! Bill Clinton effect if pt needs CABG! our cardiac team will throw a fit.
4.NEVER EVER give Dr. XYZ's pt blood unless HGB less than 6.8, SERIOUSLY! (even if he's not Dr. XYZ's pt, if XYZ has operated on pt in past 6 month, don't give it!!)
etc, etc
Resident's on cardiac service know this, but when we get pt's on family med or internal med with ACS on the floor with the cardiac consult...that's when the nurses start looking at each other out of the corner of our eyes and mumbling, "holding lovenox and plavix until consult is over".

Do the specialties ever tell the residents these little preferences??

No. And it would be nice if you nurses would, instead of just ignoring the order. I am always appreciative of nurses who keep me out of trouble, but it's hard to tell which ones are doing that and which ones are just on a power trip.

 

[Purifyer]

Another thing I want to know is, there are certain things it seems the residents and interns aren't sure of...the unwritten rules...

1.no am lovenox if you think pt is going to cardiac cath lab, pm lovenox ok
2.angiomax is ok on floor for HIT pts, not used often but it's ok
3.never, never, never give plavix precath!!!!! Bill Clinton effect if pt needs CABG! our cardiac team will throw a fit.
4.NEVER EVER give Dr. XYZ's pt blood unless HGB less than 6.8, SERIOUSLY! (even if he's not Dr. XYZ's pt, if XYZ has operated on pt in past 6 month, don't give it!!)
etc, etc
Resident's on cardiac service know this, but when we get pt's on family med or internal med with ACS on the floor with the cardiac consult...that's when the nurses start looking at each other out of the corner of our eyes and mumbling, "holding lovenox and plavix until consult is over".

Do the specialties ever tell the residents these little preferences??

I can't remember the papers now (I'm a surgical resident) but there is good evidence for 600mg plavix before angio/stenting... in terms of reducing mortality.

http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

2 seconds on pubmed. If someone has disease not amenable to angioplasty, they can chill for a few days if the surgeon doesn't want plavix on board/ or they can transfuse. If there's a dissection or something 2' to the angio... well they have to go to theatre regardless..

I guess my point is that there is no 'right' answer in many situations... nurses don't seem to get that because they tend to work in one area under a few doctors... and they think how these doctors perform is 'THE RIGHT WAY'. I mean, I'm grateful when a nurse will tell me 'Yeah.. ahh this is Dr so and so's patient, and he gets pissed when you do this'... but without the rolling of eyes please.

 

[fab4fan]

I didn't see rudeness conveyed there. Pretty much a cut and dried list of what you wanted, did not want.

I don't understand why some nurses take it as an insult when docs don't want to be their "friends." I think it's possible to have a pleasant work environment, and it's definitely a lot more enjoyable when you have some people you can joke around with (time allowing), but it isn't necessary to provide patient care. What is necessary are the kind of things Tired outlined.

I really wouldn't want to socialize with the docs I work with. I see enough of them every day. I want to be around non-hospital people IRL.

And bomb-paging people is just wrong. It must be a phenomenon of large, academic hospitals--that's why I don't see it where I work. We're just a small teaching hospital.

 

[Farmer Jane]

I'm with you all. I'm one of those incredibly nice nurses that medical students and residents just love (this may or may nor be related to my abundant love for baking that exceeds my ability to eat ) but that niceness would be nothing without competence and professional respect. Of course, the professional respect is a two way street, but I find that if I start out giving it I'll generally get it in return.

I love threads like this, because it helps me see things from the physician's point of view. The more I understand the other viewpoint and act accordingly, the better things are for everyone.

 

[telenurse]

I can't remember the papers now (I'm a surgical resident) but there is good evidence for 600mg plavix before angio/stenting... in terms of reducing mortality.

http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

2 seconds on pubmed. If someone has disease not amenable to angioplasty, they can chill for a few days if the surgeon doesn't want plavix on board/ or they can transfuse. If there's a dissection or something 2' to the angio... well they have to go to theatre regardless..

I guess my point is that there is no 'right' answer in many situations... nurses don't seem to get that because they tend to work in one area under a few doctors... and they think how these doctors perform is 'THE RIGHT WAY'. I mean, I'm grateful when a nurse will tell me 'Yeah.. ahh this is Dr so and so's patient, and he gets pissed when you do this'... but without the rolling of eyes please.

I agree there is good evidence for plavix preload...but it is the preference of our cardiac team to not give plavix until after stent is placed...then the pt is loaded with plavix. This is the agreement between the cath lab and the cardiac surgeons, it has been relayed to the ED MD's also, but sometimes when rotations change some intern/resident slips through the cracks.

I do my best to remind the residents about no am lovenox...but a few rotations back several residents were having us give it anyways and then we were having problems with post cath bleeding...so now if the resident won't listen to the nurses, and the pt looks like a cath lab possibility, I'll hold the lovenox until after the cardiology consult...usually lovenox is due at 0700, consult is over by 0830ish...
(sorry about late posting this...between overtime and migraines, getting on a computer has been near impossible)