Intern Year starts tonight!

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docdagamecock

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So tonight is the night I start my intern year, I'm starting on nightfloat and I'm terrified! :scared:

I have no idea what to expect!!!

So for all you vets out there, can you give me some last minute intern survival tips?! :xf:
 
suggestions are to bring a toothbrush, fresh pair of socks, snacks, and have your upper level's phone number to txt with questions. have fun.
 
docdagamecock said:
So tonight is the night I start my intern year, I'm starting on nightfloat and I'm terrified! :scared:

I have no idea what to expect!!!

So for all you vets out there, can you give me some last minute intern survival tips?! :xf:
Click to expand...

Just like Trinity, no real tips... sorry. 🙁 All I know is that I am terrified enough to start my 3rd year clinical rotations tomorrow... I can't imagine being on call as an intern. Just believe that you have learned what you need to... otherwise they wouldn't let you take call, right? 😎

Congrats on getting this far! I'm sure that things will be fine for you, as a former RT that has dealt with several classes of interns, all I can recommend is to utilize the nursing/RT/support staff. They know that you are scared, and most won't take advantage of you to get what they want... most won't... I guess I did have some advice to offer after all... hope it is somewhat useful. Just think... you are a doctor! This is what you wanted to be, you will excel at it!

In about 3 weeks, after you are burnt out on your intern year, just keep your eye on the CA-1 prize! :laugh:
 
Honest to God, just relax, you will be fine. You know how nervous you are just before giving a speech, but how things go fine once you get rolling? Intern year is like that.

Believe me, if I made it, anybody can. I mean it.
 
Calm down. The expectations of incoming interns are very low. Have a very low threshold for calling your senior resident/attending if you have any questions. It is much better to be conservative at this point. Carry your ACLS card in your back pocket to remind you of the algorithm.

Here's what will happen:

6pm (or whatever time): show, up, get sign out about the folks you're caring for overnight.
6:01 ER will have some 80 year old woman who "just doesnt look right" or is "feeling a little weak". You will admit said octogenarian. This will be the first of 750 such admissions you will have this year. This will entail seeing the pt in the ER, calling your attending/senior, putting in the admit orders ( your senior can help you with this), and then repeating this process several more times overnight.

7pm: nursing shift change.
730: nurses start looking at charts. They start calling you about ambiguous orders from 6 hours before. If it's critical to fix overnight, then fix it.
8pm: Nurses would like things to quiet down, so they will call you asking for ambien, benadryl, trazodone, or zyprexa for their patients. Recognize that most people don't go to bed at 8 pm, and will have a hard time sleeping with the lights on, and the TV blaring. Get the pt a good sleeping environment, and dispense sleepers VERY judiciously.
9pm: ER will have 2 more patients for you.
1030: The obese COPDer will refuse his CPAP and will desat all night long.
2am: Recently graduated RN will be reviewing the I/O's and notice that the pt in bed 507 hasn't had a bowel movement. Remind her that unless they are being prepped for a colonoscopy overnight, most people don't poop at 2am. Be very nice.
1200- 6am: people will have actual issues requiring intervention. Know how to contact the rapid response team for an acutely decompensating patient. CALL YOUR SENIOR.
4am: labs will come back and people will page you about abnormalities. Ask your senior how to replete electrolytes (since somehow they never taught us the specifics of this in medical school).
6am: sign back out the various things that you did overnight.
620: your first night of call as an intern is over, hopefully everyone that was alive when you came in is still alive.

Things that will help: Keep a list of all the patients you have to care for and any time you are called or do anything to/for them, write down what you did and what time it was. IF you can, also have available the reason for admission, any relevant pmHx, allergies, CODE STATUS, and current rx.

Good luck. We all got through it, you can too. ASK FOR HELP if you don't know. It is better to look foolish and ask questions than to save face and risk hurting someone.
 
Don't be afraid to admit that you don't know something. Don't hesitate to ask for help from your senior resident and the nursing staff and anyone who is willing to help or teach you something. You can learn a lot from others, especially the nurses if your senior resident, attending is not around. If you go in with a humble attitude and show people that you are willing to learn and mature, they will respect you greatly. And enjoy, this is what you have been waiting for. You have the privilege of doing something that many people can only dream of. Cheers.
 
geogil said:
Calm down. The expectations of incoming interns are very low. Have a very low threshold for calling your senior resident/attending if you have any questions. It is much better to be conservative at this point. Carry your ACLS card in your back pocket to remind you of the algorithm.

Here's what will happen:

6pm (or whatever time): show, up, get sign out about the folks you're caring for overnight.
6:01 ER will have some 80 year old woman who "just doesnt look right" or is "feeling a little weak". You will admit said octogenarian. This will be the first of 750 such admissions you will have this year. This will entail seeing the pt in the ER, calling your attending/senior, putting in the admit orders ( your senior can help you with this), and then repeating this process several more times overnight.

7pm: nursing shift change.
730: nurses start looking at charts. They start calling you about ambiguous orders from 6 hours before. If it's critical to fix overnight, then fix it.
8pm: Nurses would like things to quiet down, so they will call you asking for ambien, benadryl, trazodone, or zyprexa for their patients. Recognize that most people don't go to bed at 8 pm, and will have a hard time sleeping with the lights on, and the TV blaring. Get the pt a good sleeping environment, and dispense sleepers VERY judiciously.
9pm: ER will have 2 more patients for you.
1030: The obese COPDer will refuse his CPAP and will desat all night long.
2am: Recently graduated RN will be reviewing the I/O's and notice that the pt in bed 507 hasn't had a bowel movement. Remind her that unless they are being prepped for a colonoscopy overnight, most people don't poop at 2am. Be very nice.
1200- 6am: people will have actual issues requiring intervention. Know how to contact the rapid response team for an acutely decompensating patient. CALL YOUR SENIOR.
4am: labs will come back and people will page you about abnormalities. Ask your senior how to replete electrolytes (since somehow they never taught us the specifics of this in medical school).
6am: sign back out the various things that you did overnight.
620: your first night of call as an intern is over, hopefully everyone that was alive when you came in is still alive.

Things that will help: Keep a list of all the patients you have to care for and any time you are called or do anything to/for them, write down what you did and what time it was. IF you can, also have available the reason for admission, any relevant pmHx, allergies, CODE STATUS, and current rx.

Good luck. We all got through it, you can too. ASK FOR HELP if you don't know. It is better to look foolish and ask questions than to save face and risk hurting someone.
Click to expand...

Very funny! Very true! Oh how I don't miss those days 🙂. Nicely done.
 
geogil said:
Calm down. The expectations of incoming interns are very low. Have a very low threshold for calling your senior resident/attending if you have any questions. It is much better to be conservative at this point. Carry your ACLS card in your back pocket to remind you of the algorithm.

Here's what will happen:

6pm (or whatever time): show, up, get sign out about the folks you're caring for overnight.
6:01 ER will have some 80 year old woman who "just doesnt look right" or is "feeling a little weak". You will admit said octogenarian. This will be the first of 750 such admissions you will have this year. This will entail seeing the pt in the ER, calling your attending/senior, putting in the admit orders ( your senior can help you with this), and then repeating this process several more times overnight.

7pm: nursing shift change.
730: nurses start looking at charts. They start calling you about ambiguous orders from 6 hours before. If it's critical to fix overnight, then fix it.
8pm: Nurses would like things to quiet down, so they will call you asking for ambien, benadryl, trazodone, or zyprexa for their patients. Recognize that most people don't go to bed at 8 pm, and will have a hard time sleeping with the lights on, and the TV blaring. Get the pt a good sleeping environment, and dispense sleepers VERY judiciously.
9pm: ER will have 2 more patients for you.
1030: The obese COPDer will refuse his CPAP and will desat all night long.
2am: Recently graduated RN will be reviewing the I/O's and notice that the pt in bed 507 hasn't had a bowel movement. Remind her that unless they are being prepped for a colonoscopy overnight, most people don't poop at 2am. Be very nice.
1200- 6am: people will have actual issues requiring intervention. Know how to contact the rapid response team for an acutely decompensating patient. CALL YOUR SENIOR.
4am: labs will come back and people will page you about abnormalities. Ask your senior how to replete electrolytes (since somehow they never taught us the specifics of this in medical school).
6am: sign back out the various things that you did overnight.
620: your first night of call as an intern is over, hopefully everyone that was alive when you came in is still alive.

Things that will help: Keep a list of all the patients you have to care for and any time you are called or do anything to/for them, write down what you did and what time it was. IF you can, also have available the reason for admission, any relevant pmHx, allergies, CODE STATUS, and current rx.

Good luck. We all got through it, you can too. ASK FOR HELP if you don't know. It is better to look foolish and ask questions than to save face and risk hurting someone.
Click to expand...

👍

My seniors did admissions and I usually helped out on 3 admissions. Typical night float would see about 12-15 admissions (never less, sometimes more). My main role was cross-cover and assist with doing admissions if things got out of hand via the ED.

Don't forget the late evening ICU transfers to the floor that need to be seen, as well.

6-6 is nice. Mine was 4p-8a. Followed by "didactics and NF review" from 8a-8:30a. Then, finally done. I usually passed out by 8:20 because these things always lasted an hour.

I do agree with the above assessment; however.
 
To the OP, here are my thoughts:

1.) Try to get at least SOME sleep overnight, even if it's just 45 minutes. It doesn't sound like much but trust me, this makes all the difference in the world the next morning when you're signing out a bunch of patients you know very little about. Your head will be much clearer and you'll make fewer mistakes/omissions if you didn't stay up all night. Usually the 02:00 to 04:00 window is your best opportunity because the labs haven't come back yet and the nurses are busy on Facebook or amazon. If possible, try to work out a system with your senior or co-intern to cover each other's pagers for a while so that you can each get some shut eye.

2.) ASK QUESTIONS!!! Seriously dude, I was afraid of looking dumb in front of residents and attendings during internship so I didn't ask many questions at first and tried to figure things out on my own. Bad idea. You're new to the system and it's ok! They don't expect you to know how things run just yet. Plus, they will respect your humility and be much more likely to treat you like a colleague if you can admit when you don't know something.

3.) Have some fun! It's not all bad despite what you may hear or read on SDN.
 
I started on night float as well, they had a senior resident available for us specifically to call with questions the first one or two nights. These residents helped us with the first calls but were largely absent after that. Haha, to prepare I bought on Xbox 360 as a graduation present to myself and played GTAIV all night and went to sleep at 08:00 waking up at 15:00 to go to the hospital. Now the second go around of night float intern year was full of good times.
 
docdagamecock said:
So tonight is the night I start my intern year, I'm starting on nightfloat and I'm terrified! :scared:

I have no idea what to expect!!!

So for all you vets out there, can you give me some last minute intern survival tips?! :xf:
Click to expand...


try not to piss off nurses. i knew a guy who was "less than pleasant" to everyone, and he got random pages all night each night the nurses noticed he was on call. they wouldn't likely do that to an attending, but a resident is fair game...
 
Last edited:
Treat everyone with respect, from the nursing staff down to the janitor who mops the floor. It will carry you very far. Don't get on the "I'm a doctor" or "my name is Dr. So and So" trip. It will get you nowhere. Stay humble, yet confident.
 
Congratulations buddy! Starting off intern year on night float will definitely put some hair on your chest.
My suggestions to you would be
1-when a nurse calls you about a patient, always seem them first before doing anything when you first start out. After some experience you'll learn what you can ignore and what can wait till the am but on your first week be very vigilant.
2-Remember that everytime you speak to a nurse, they are likely documenting your name in the chart as notified
3-Never hesitate to call your senior. Although he might not have anything to add, it's good to "load the boat" early on
4-In the morning during sign out, be nice but firm. ALWAYS ALWAYS let the primary team know what they forgot to do and something stupid you got called about. It's your job to cover for the night, not to write orders that should have been in the day time. I used to cover for an intern who defined the word sloppy-his team would keep me up the entire night. After I put him on the hot seat a few times, he got it together. If you are too nice, you will get dumped on (which happened to me at first until I wisened up)
5-No matter how bad they can hurt you, they can't stop the clock!

Good luck
 
Hawaiian Bruin said:
When in doubt- always go see the patient.
Click to expand...

Huge +1.

Just like EKGs, the more normals you see, the easier it is to tell when one's abnormal.

The only downside of going to the bedside when you are called is the energy it takes to get outta bed and lay eyes and/or hands on the patient.

It'll make you a better clinician and it may even earn you respect from nurses.
 
Thanks for all the tips and help!

Survived the first night and still pushing.

True Story:
Arrived to the hospital 45 minutes early, but still managed to almost be late to check out because I couldn't find the lounge. I was going from floor to floor getting more stressed until when I gave up, I happened to walk by a room that looked familiar and popped in right on time. As soon as I greeted the other two interns a MET was called and my upper level was running late and hadn't arrived yet, so the only doctors around to respond were my fellow interns and I! A real sphincter tightener!

Thankfully, our upper level ran in and caught us in transit. I thought they were gonna have to call a MET for me.
 
Lots of good advice above. I can't stress enough how important it will be to see the patient and call your senior.

find some way to organize yourself... I used checkboxes with a quick highlighter through the box to make it stand out.

If the box was highlighted and wasn't checked off... I had to either do-it or be ready to sign it out to the call team. If the box was checked, it was done. This might seem silly, but you'll be covering so many generic patients with similar complaints that you might not remember if you repleted Mrs So-and-so's K... if the box is checked, you did.
 
sometimes going to see the patient both benefits the patient and treats the nurse. Young as we both are in our training (OP and I), sometimes the nurses derive an extra measure of security from just having someone else alongside them when they are concerned about a patient...little as we know. It also says something about your evaluation of their competence when you take their concerns seriously.


And it gets back to attendings if your attitude is perceived as nonchalant.
Please don't start out that way.

I am starting PGY3 year in a few days and I still go see every single patient, sometimes even the calls for trazodone/ambien.
 
You will get calls/requests phrased in such a way that the nurse wants a specific thing from you... ALWAYS ask yourself if this is what YOU want for the patient.

Is the patient not making urine because they need lasix or fluid?

Do you actually want to treat the temp of 100.6? Should you be investigating why the patient's temp is up?

Do you really want to give ativan to the 90 year old mildy demented dude who you're planning to d/c tomorrow?

Do you really want to give a PRN IV anti-hypertensive to the dude who just got his evening anti-hypertensives and is now sitting at 140/90? (Interestingly, I had a nurse call my senior when I didn't treat in this situation... she started calling consult services when he didn't do anything)

There will be plenty more things like this, you will want to see the patient if you have any doubt.. if you've got a nurse that wants treatment and you disagree, explaining your logic will usually resolve the question.
 
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