EM programs with strong nursing?

[Chrismander]

---

Members do not see this ad.

What are your perspectives on which programs have strong nursing and quality ancillary staff? Is this important or are most teaching ER's so resident driven that it doesn't really matter (i.e. having residents do lots of things that nurses or techs would do at private non-teaching hospitals in the 'burbs). Thoughts?

 

[EctopicFetus]

From my experience Arizona and Orlando both have strong nursing. Keep in mind that if you want to start an IV they will be more than happy to let you. I start them once in a while to keep in practice.

 

[turtle md]

Christiana is a private teaching hospital with great nursing and support staff.

 

[southerndoc]

I think we (Yale) have very strong nursing. I can count on one hand the number of times I've started a peripheral IV, done a Foley, etc. Of course this doesn't include the IV's I've done under ultrasound guidance or EJ's because the nurses couldn't get a peripheral (nurses aren't allowed to do EJ's in Connecticut).

The only thing we do frequently that I think is a waste of time is that residents must draw our own ABG's. Respiratory therapists won't draw them in the ED, and when you're in the ICU's, you have to have a reason for them to draw them. It's a pain when you're rounding, someone needs an ABG, and you have to ask the RT to draw it so you can participate in rounds. They are usually reasonable with it: if you are busy dealing with another patient, doing another procedure, or rounding, they will usually draw them.

 

[EctopicFetus]

So here in AZ we have medics who do our lines including EJs. As mentioned we do have to do our own central lines and US guided lines. ABGs are respiratory unless we want to do it.. Lastly if the nurse cant do the foley.. we usually try but if they cant do it I doubt we could.. Its Uro time.. FWIW I have NEVER seen Uro called for a foley insertion!

 

[MushieCookie]

Beth Israel Manhattan...I'm a 4th year rotating there.
Nursing is great. Very little 'scut' for residents, unless they want to do peripherals and such. Nice gig they've got there...

 

[basementbeastie]

i think that the general benefit to strong nursing and ancillary staff is that they allow you to function (most of the time) as a physician...this is what you are training for, after all. i do think that your 'ancillary staff skills' should be developed as well but that should be more at your leisure than out of necessity...most of your time should be spent examining patients, developing plans, high end procedures, discussions with consultants, etc....oh yeah, documenting the above.

 

[basementbeastie]

this has probably been discussed at length sometime in the past....a search may be fruitful....

 

[beyond all hope]

You don't want to work at a place with bad nursing. Been there, done that.

That being said, some of the best residencies in the country are county facilities with crappy ancillary staff. Usually ER nurses are pretty good everywhere (with many notable exceptions). The real place you'll run into problems are your floor rotations.

 

[dchristismi]

Great ancillary staff at Orlando, IMHO.

I agree with Beastie - it's important to learn to do these things, but your main priority should be learning to be a physician.

 

[crewmaster1]

There will be kick ass nursing wherever I match (I'll let you know, don't worry), because my wife is an awesome ER nurse and she's coming where ever I match!

 

[FoughtFyr]

What are your perspectives on which programs have strong nursing and quality ancillary staff? Is this important or are most teaching ER's so resident driven that it doesn't really matter (i.e. having residents do lots of things that nurses or techs would do at private non-teaching hospitals in the 'burbs). Thoughts?

Mayo has "magnet status" for nursing and all of our ancillary teams are great. We male and female cath team, pediatric IV teams, ABG teams, etc. etc. We even have "child life specialists" dedicated to the ED to distract pediatric patients during painful procedures. But a resident can do whatever procedures they want to in order to stay good at them.

- H

 

[roja]

BI in manhattan and SLR in manhattan (and LIJ but I am not sure personally) are all run by the same org. all have great nursing. Our interns start out doing peripherals so that they learn how. Otherwise, its done by nurses.


Strong nursing is important. I ranked some NYC places lower because the ancillary was so bad.

 

[jazz]

poor ancillary services which result in residents transportating pts and starting iv's all the time, takes away from teaching/learning/"cool" procedures.

however, you also don't want to graduate from a residency where you don't know how to put in a peripheral iv b/c you've never had to, or not known how to splint a fracture b/c you had techs do it etc, etc.

you never know, you may end up at job after residency where ancillary isn't great or where when you may be looked at as the "best" person to get a peripheral iv in a kid, or poor iv access adult,etc...

definitely, though, things like emptying bed pans, transfering patients, undressing pts, etc is more of a waste of time from learning....

having some ancillary skills is not a bad thing to have...

 

[Hercules]

We have excellent nursing and ancillary staff here at UAB. Like everyone else has posted, you can do peripherals, ABG's, etc if you want to hone those skills. Nurses can't do EJ's here so we do put those in if needed, but it's extremely rare that one of our nurses can't get a line in. It's nice to be able to focus on doing MD procedures and learning instead of pt transport and scut.

 

[deleted52758]

i go to cook county and we have the best nurs....

i almost got through that sentence without laughing.

 

[Dr. Will]

Rotating thru Cook county, UC Davis, and Jacobi (still here) I can tell you first hand that UC Davis has a great ancillary staff. As for Cook and Jacobi...well if you can't say something nice then don't say anything at all. 😀

 

[FoughtFyr]

however, you also don't want to graduate from a residency where you don't know how to put in a peripheral iv b/c you've never had to, or not known how to splint a fracture b/c you had techs do it etc, etc.

you never know, you may end up at job after residency where ancillary isn't great or where when you may be looked at as the "best" person to get a peripheral iv in a kid, or poor iv access adult,etc...

You have teams for splinting?!? Wow, I thought Mayo had the market cornered on "teams".

- H

 

[Dukes]

Granted I completed my med school rotations at NYC hospitals without the greatest ancillary staff the nurses and techs at EVMS are amazing. Infact there are times when I wish there weren't so good so I could put in more EJs etc.. R-Techs do the ABGs and you won't have to transport anyone anywhere.

 

[sweetfynesse]

BI in manhattan and SLR in manhattan (and LIJ but I am not sure personally) are all run by the same org. all have great nursing. Our interns start out doing peripherals so that they learn how. Otherwise, its done by nurses.


Strong nursing is important. I ranked some NYC places lower because the ancillary was so bad.

nurses...at SLR...great? roja, that was a joke...right.

having graduated with you, i feel qualified to help lead you back into reality.

sure, if you're only comparing nurses in new york (or only comparing bad nursing systems), then SLR probably does have the better ones. but on a whole, they are far from great.

keepin' it real

 

[roja]

nurses...at SLR...great? roja, that was a joke...right.

having graduated with you, i feel qualified to help lead you back into reality.

sure, if you're only comparing nurses in new york (or only comparing bad nursing systems), then SLR probably does have the better ones. but on a whole, they are far from great.

keepin' it real

Don't be hatin!😎 The bad ones are only in peds... 😀

 

[jazz]

You have teams for splinting?!? Wow, I thought Mayo had the market cornered on "teams".

- H

not where i trained but definitely i know of ER residency programs where techs do the splinting....

one time, met someone from an ER residency that was rotating through our peds hospital er, who didn't know how to splint b/c they never had to at their homebase hospital...

 

[beyond all hope]

Roja, like all SDNers I am madly in love with you, but I have to disaree with you.

Ancillary staffing in NYC sucks, in general. Yes, SLR/BI is better than the HHC hospitals (Jacobi, etc) but still bad. That's one of the reasons I work on the island. I've had nurses at SLR tell me 'medical students start all of their own lines'.

It's almost impossible for ancillary to live in NYC on their meager paycheck, so the nurses that work in the EDs are usually pretty bad. Compare that to suburban hospitals or the midwest and you'll understand.