Be as nice as you can be, but be prepared to piss people off when it's necessary for patient care.
Listen to the nurses. Then do the right thing, even if it isn't what the nurse wants. Always talk to the nurse respectfully and let them know why you are doing what you are doing instead of what they want. If it involves an issue of patient comfort (e.g., sleeping pills), offer to talk to the patient.
Always be professional. Speak in measured tones when there is conflict. Avoid conflict when possible, but when not just stay professional.
No matter how busy or overwhelmed you are, no matter how angry you are at your seniors or attendings or the nurses or the schedule, don't take it out on your patients or your family.
Don't shut off your phone or pager when you leave the hospital. Yes, you will get called on your time off, but it's really frustrating for the nurses when they can't get ahold of anyone, and dangerous for the patient when there is a half hour delay because the nurse tried paging you twice, waited 15 minutes before paging you again, then waited another 15 minutes before trying to figure out who else to call.
Go see the patient when called. Avoid knee jerk orders overnight (zofran is great for nausea, but please don't do it for a patient with a bowel obstruction... the next day, no one is going to accept 'it was a cross cover' as an excuse).
RN wanting the patient to go to the unit is an indication for unit transfer. Why? Because while from a doctor level it might not be an ICU patient, if the RN has 4-8 other patients who are not being cared for because of the level of nursing care required, there is a problem. Just be very specific when you call your senior about why you want to transfer the patient ("After speaking to the charge nurse and the bedside nurse, it's become clear that the level of nursing care required excedes the ability of this unit -- in particular, X, Y, and Z.").
Call your seniors. Any time you call your senior, write in the chart a SOAP note which describes the patient's situation that prompted the call, and in the plan section documents that the plan was discussed with "Dr. White, senior surgical resident on cal" "Dr. Blue, attending of record."
If you are responsible for assuring blood availability for the OR, call the blood bank the night before and document in the chart "Spoke with Ms. Red of the blood bank, who stated that two units of packed red blood cells and four units of FFP would be available for the operating room tomorrow". This will save you much heartbreak.
DO NOT SIGN OUT IN THE MIDDLE OF A CODE. It sounds obvious, but you'd be surprised what people do in the age of the eighty hour work week. If you need to, talk to your senior and say "I'll be in late tomorrow, I have a patient who was actively coding and stayed late." or "I'm going to be over 80 hours, is there a day I can come in late or leave early this week?"
Try not to sign out unstable patients who lack a plan. See above for strategies for doing this within the 80 hour work week. As strict as one must be in following these rules, there is sufficient flexibility in the rules to prevent you from really having to do this. The first time one of your co-interns signs out a crashing patient that you don't know at all, and you don't get a plan because one hasn't been decided on yet, and you are covering 20 of your own team's sick patients... you'll understand the problem. It's dangerous for the patient, and frustrating for you.
Don't screw over your co-interns. Don't do it with the schedule, don't do it with leaving early or coming in late. If there are two of you on a team, help each other out -- yes you can get away with doing less work since the other guy will pick up the slack, but it's poor form.
Be nice to the NPs and PAs. They will be helpful. When they are lazy or dumb, just ignore them and make sure your patients get the care they should. Even if the NP/PA is "doing everything" realize that as the intern you are expected to know everything going on with your patients.
If you see consults as an intern, be a polite consultant. Don't try to "block" consults.
Follow up on studies and tests -- if your resident or attending tells you to get a CT scan on Mrs. Jones, you should know the results, or if the results aren't back yet where we are in the process ("CT is done but not read" ["have you looked at it?" "Yes, and I thought I saw ____ but I'm not sure"], "She's scheduled to go down at 3 p.m."].
Write everything down. You will forget. If you don't forget now, you'll forget later.
Keep a good list -- test results, where your patient is, etc.
Best,
Anka
