Nursing duties of Anesthesiologists

[Katheudontas parateroumen]

Hey friends,

So I'm finishing up my intern year in internal medicine. I understand we have a lot of anesthesiology to learn... but what about the nuts and bolts of the nursing duties we also do that we don't learn in med school/intern year? Like I have no idea how to draw blood, set up IV pumps, etc.. What are some of those type of skills that we should know before starting?

Thanks!

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[MoMoGesiologist]

Getting breaks, complaining about not getting your breaks, complaining about having to give breaks, complaining about not getting relieved on time. Those are the most important. Also, putting on monitors, transporting patients, emptying folies.

 

[narcotics999]

Hey friends,

So I'm finishing up my intern year in internal medicine. I understand we have a lot of anesthesiology to learn... but what about the nuts and bolts of the nursing duties we also do that we don't learn in med school/intern year? Like I have no idea how to draw blood, set up IV pumps, etc.. What are some of those type of skills that we should know before starting?

Thanks!

You are finishing up intern year and don't know how to draw blood?

 

[nimbus]

You are finishing up intern year and don't know how to draw blood?

OP must have attended a very classy medical school, probably not in New York City.

 

[Katheudontas parateroumen]

You are finishing up intern year and don't know how to draw blood?

Honestly, I've only drawn blood a few times in 3rd year of med school. So i really don't know when I can draw blood from an IV or not, which tube top means what, etc.

 

[woopedazz]

I don't know how they do it in the US, but if an intern didn't know how to take blood at the start of the year they'd get ripped into. If they didn't know how to do it near the end, they'd fail internship.

Get to work early and do your own phlebotomy rounds or something.

 

[pgg]

Honestly, I've only drawn blood a few times in 3rd year of med school. So i really don't know when I can draw blood from an IV or not, which tube top means what, etc.

If the nurse in the OR doesn't know which color tube to use, just fill one of each and let the lab figure it out.

 

[San Marzano]

I don't know how they do it in the US, but if an intern didn't know how to take blood at the start of the year they'd get ripped into. If they didn't know how to do it near the end, they'd fail internship.

Get to work early and do your own phlebotomy rounds or something.

In the US there is a group of employees at the hospital called phlebotomists and their job is to scurry around drawing blood all day and all night. In the ED the RN takes blood when the IV is started. Never heard of an intern drawing blood before.

 

[anbuitachi]

In the US there is a group of employees at the hospital called phlebotomists and their job is to scurry around drawing blood all day and all night. In the ED the RN takes blood when the IV is started. Never heard of an intern drawing blood before.

Interns get called for the hard sticks, and they also get called for hard IV placements. This is in the Northeast where i trained.

Hey friends,

So I'm finishing up my intern year in internal medicine. I understand we have a lot of anesthesiology to learn... but what about the nuts and bolts of the nursing duties we also do that we don't learn in med school/intern year? Like I have no idea how to draw blood, set up IV pumps, etc.. What are some of those type of skills that we should know before starting?

Thanks!

If you can put in IV , you can draw blood. Nurses use butterflies but we often use IV catheters to draw blood (draw it before you look it up to IV set). As an intern, i had very few venous draws. If it involved a vein it was for IV placement. For draws it's mostly arterial sticks that interns here get called for.

Dont worry about it too much. you'll learn once you start anesthesiology. Setting up pumps depends on what types of pump they use. Different hospital often use different pumps.

 

[vector2]

This thread again confirms that med students/interns don't do enough ICU or don't do anything when they are on ICU. If you order norepi to be started on a pt, have the nurse show you how to set up the pump and tubing. Need blood cultures, get them yourself. ABG, do it yourself. Intubation, ask the doc if you can take the first look. Difficult iv, get the u/s and start sticking. Need a central line, be the first to volunteer. Concern for DVT, look up how to scan on google and put the probe on while you wait for the rad tech to do the official study.

I try to beat it into our anesthesiology interns that they are not just another IM intern. For any procedure or critical pt on their service, they should be the first one in the room- not the first to pick up the phone and call someone else.

 

[deleted875186]

This thread again confirms that med students/interns don't do enough ICU or don't do anything when they are on ICU. If you order norepi to be started on a pt, have the nurse show you how to set up the pump and tubing. Need blood cultures, get them yourself. ABG, do it yourself. Intubation, ask the doc if you can take the first look. Difficult iv, get the u/s and start sticking. Need a central line, be the first to volunteer. Concern for DVT, look up how to scan on google and put the probe on while you wait for the rad tech to do the official study.

I try to beat it into our anesthesiology interns that they are not just another IM intern. For any procedure or critical pt on their service, they should be the first one in the room- not the first to pick up the phone and call someone else.

While this sounds good in theory, I did IM year and it’s isually not always possible. IM residents don’t do many procedures, and senior residents usually want to do all the procedures. IM residency emphasizes note writing, coordinating care, making phone calls, etc, so your usually busy with other things. But yes, try and do as much as possible. In your free time and light rotations, go down to the ED and start IVs when patients come in. Other than that, I wouldn’t worry about it and just get through the year.

 

[DocVapor]

Hey friends,

So I'm finishing up my intern year in internal medicine. I understand we have a lot of anesthesiology to learn... but what about the nuts and bolts of the nursing duties we also do that we don't learn in med school/intern year? Like I have no idea how to draw blood, set up IV pumps, etc.. What are some of those type of skills that we should know before starting?

Thanks!

If you can, show up early every single day and ingratiate yourself with the pre-op nurses and get them to let you start as many IV's and do as many lab draws as possible before your assigned duties start. The only problem is that they're going to show you all their "little tricks" they have for getting an IV, which will seem cool and give you some confidence. Then once you're in the OR and starting second IV's, get your attendings to show you and talk to you about how to really do it. It won't be long before you realize that Pre-Op nurses that have been starting IV's for 30 years won't even come close to your skills, as you'll regularly have to bail them out in the future.

 

[IMGASMD]

Did IM residency along the way at two institutions. One was bougie as hell, the other was at the bad part of the town.

As an intern, i did a-line, TLC without ultrasound, I learned from an old timer nurse if you can’t get any blood on patients, you close the curtain and draw from deep AC area (euphemism for brachial artery). As a doctor you get to do a lot more. As long as you can justify your reasoning, you are good. Oh and the infamous, IV in the foot. “Only physicians are allowed to place IV there, nurses can’t even look “

As IM senior resident, I barely touched patients, because of the culture of the second institution. We had phlebotomy team that will do all blood draw. We routinely place patient on pressors without central line or a line. Because central line were placed by surgery, and we didn’t have a surgical residency.

IM experiences can be vastly different at different parts of the country. However, as others have pointed out, anesthesia is not IM. You will need to be proficient to do all these procedures, because ain’t nobody’s gonna bail you out in the middle of the night when you and you alone are it.

It won't be long before you realize that Pre-Op nurses that have been starting IV's for 30 years won't even come close to your skills, as you'll regularly have to bail them out in the future.

Had to recently bail out PICU, where you would think they place IVs into kids every single day..... he had a pitiful 24g in. Found a 20, (I apologize to those who believe “bigger is better” mantra) in one shot. The kid was awake, crying with family members at bedside. It was a good day.

 

[LunchMD]

My surgical internship upper levels did all central lines, chest tubes, etc. Respiratory therapy did all a-lines and art sticks. Interns were called for difficult IV access to do US guided IVs. Noone taught us, we just had to learn on patients by ourselves in the middle of the night. Had to call the anesthesia resident in the unit to save my butt on a floor pt once for an IV.

 

[coffeebythelake]

the OP should reword the title. these are not "nursing duties"

 

[woopedazz]

In the US there is a group of employees at the hospital called phlebotomists and their job is to scurry around drawing blood all day and all night. In the ED the RN takes blood when the IV is started. Never heard of an intern drawing blood before.

You have phlebotomists on call overnight? And interns don't have to do urgent bloods themselves? I thought the Australian system loved to burn money. That seems crazy to me.

 

[San Marzano]

You have phlebotomists on call overnight? And interns don't have to do urgent bloods themselves? I thought the Australian system loved to burn money. That seems crazy to me.

That is correct! Didn’t realize I had it so good! Mind you I’ve been working in one particular hospital system but all five hospitals in this system have operated that way.

 

[LunchMD]

We had the 24 hour phlebotomists too. We also had nurse techs. So nurses often didn't get vitals, move patients, etc, it would be the nurse techs doing that. How long until certified nurse technicians demand independent practice? (joking)

 

[mmag]

Setting up an IV pump is pretty straightforward - find out what kind of pumps your hospital uses and look for a video on youtube. You don't need a 3 hour in-service like the nurses get on how to use pumps - it's not that hard. They were designed for someone with a community college degree to use. Alaris and Plum are two popular ones.

Watch some IV start videos. Start IV's on asleep patients with your attending until you get more comfortable.
You can problem solve and learn on your own the basics. Use your attending as a resource, get all of your questions answered the first month when you are one on one. Your attending can give you tips and tricks. Don't worry about looking stupid because hey it's the first month and what else are they gonna do when they are forced to spend the whole case with you 1:1.

 

[mmag]

You definitely need to know how to empty a foley to measure output. Ask for an empty irrigation bottle from the circulator. Once again don't sweat it; certified nursing assistants can do it but if you want to watch

 

[Planktonmd]

There is a major difference between anesthesiology and all the other specialties, We actually don't depend on anyone and do not have the luxury of barking orders at nurses and walking away hoping that our orders will be executed.
Some might see that as a disadvantage but I see it as a privilege.

 

[MirrorTodd]

Fair warning...nursing MAAAAYYYYYYY flip their **** if you start messing with their pumps on the floor. We've had patient safety reports called on us for adjusting the pumps in the SICU after we put in our orders and the pumps still weren't changed. That's probably institutional dependent, but some people are very territorial about their **** being messed with.

 

[dingdong28]

If the nurse in the OR doesn't know which color tube to use, just fill one of each and let the lab figure it out.

I know I shouldn't comment here as I'm not an attending (just a lab tech) but you can always call us to ask what test is needed for each tube rather than drawing excess tubes and then the test(s) requested are not drawn in their respectable tubes! I know it's a pain in the a$$ to call but at least it saves you the frustration of having the test delayed, reordering the test again (depending on the lab, they'll cancel the test because it was drawn in the wrong tube) and the patient from having unnecessary phlebotomy performed (with the possibility of the specimen being hemolyzed, clotted, contaminated from the line, etc. and needing to be drawn a 3rd time). Plus, I enjoy when I get the occasional call from an anesthesiologist about blood products and tests being ordered since they are very respectable on the phones unlike most other staff I've had to call for critical values, incorrect orders, etc. Thanks for reading!

 

[IMGASMD]

Fair warning...nursing MAAAAYYYYYYY flip their **** if you start messing with their pumps on the floor. We've had patient safety reports called on us for adjusting the pumps in the SICU after we put in our orders and the pumps still weren't changed. That's probably institutional dependent, but some people are very territorial about their **** being messed with.

Along with that, respiratory at my institution also don’t like us adjusting the settings we gave them. Or nurse doesn’t want us to touch the vent. Or something that I don’t quite understand.

Every time I adjust the vent, PACU nurses flip their ****, even though the vent setting is the one I gave to respiratory and I am the one who’s actually managing the PACU patient and I am the one physically changing the vent.

Why do I have to write another order and wait for respiratory to come when I can do it myself right there and then?! Haven’t figured this one out yet.

 

[Cryc_to_the_point]

How can they get mad about you executing your orders?

 

[Mman]

In the US there is a group of employees at the hospital called phlebotomists and their job is to scurry around drawing blood all day and all night. In the ED the RN takes blood when the IV is started. Never heard of an intern drawing blood before.

I'll just assume you never rotated at a VA.

Phlebotomists worked 7-3. Every other lab draw was done by the residents and med students. We did "vampire" rounds on call in the evening to draw all the troponins and blood cultures and H&Hs and what not teams had ordered for their patients when they signed out to us. We had this at the VA I rotated at as a med student and again as a resident in a different state.

 

[Morzh]

This thread has opened my eyes to how spoiled I am at the hospitals in my residency program (which includes a county hospital, private hospital, and a VA)... at all three we have phlebotomists for routine / scheduled labs, but floor and ICU nurses will draw any lab at any time 24h/day at my request, no questions asked. I've never drawn my own blood outside of the OR. I've only started floor IVs as an intern when I wanted to practice my US-guided line skills or was asked to help on a difficult stick patient. I can also change pumps and vents in the ICU as I please, as long as I tell the nurse/RT to avoid confusion and then modify the order within a reasonable amount of time.

Maybe it's a regional thing? Maybe the nursing unions in the NE (opposite of where I am, no unions here) have decided lab draws aren't part of a nurse's duties and got that written into their contracts?

 

[anbuitachi]

This thread has opened my eyes to how spoiled I am at the hospitals in my residency program (which includes a county hospital, private hospital, and a VA)... at all three we have phlebotomists for routine / scheduled labs, but floor and ICU nurses will draw any lab at any time 24h/day at my request, no questions asked. I've never drawn my own blood outside of the OR. I've only started floor IVs as an intern when I wanted to practice my US-guided line skills or was asked to help on a difficult stick patient. I can also change pumps and vents in the ICU as I please, as long as I tell the nurse/RT to avoid confusion and then modify the order within a reasonable amount of time.

Maybe it's a regional thing? Maybe the nursing unions in the NE (opposite of where I am, no unions here) have decided lab draws aren't part of a nurse's duties and got that written into their contracts?

Nah nurses here still draw blood . But at least the culture here is they are the first line. If they cant get it they tell the doctor. So in the end all responsibility falls on the doctor.

 

[IMGASMD]

How can they get mad about you executing your orders?

Very easily. Almost on a daily basis.

I’ve had nurse telling me I need respiratory to be there to extubate my PACU patients. Because respiratory needs to turn off the vent or something. I then put on my RBF, pull the tube and say GTFOH.

 

[IMGASMD]

Nah nurses here still draw blood . But at least the culture here is they are the first line. If they cant get it they tell the doctor. So in the end all responsibility falls on the doctor.

I’ve learn to accept, if phlebotomist cannot draw, it becomes a “difficult draw”. Most nurses will not attempt any second try. Because if phlebotomist who does this daily, cannot draw, nurses should just accept the defeat. Call the residents.

 

[San Marzano]

I'll just assume you never rotated at a VA.

Phlebotomists worked 7-3. Every other lab draw was done by the residents and med students. We did "vampire" rounds on call in the evening to draw all the troponins and blood cultures and H&Hs and what not teams had ordered for their patients when they signed out to us. We had this at the VA I rotated at as a med student and again as a resident in a different state.

One of the hospitals in the system is a VA indeed. Did many nights on call there as an intern and never once drew blood.

 

[Mman]

One of the hospitals in the system is a VA indeed. Did many nights on call there as an intern and never once drew blood.

consider yourself lucky to not have the work and unlucky to never have to learn how to do the job well as an intern

 

[abolt18]

consider yourself lucky to not have the work and unlucky to never have to learn how to do the job well as an intern

I was doing medicine at the VA a few months ago and never got call for IVs and never drew blood. If it was outside the 7-3, it was done by the patient's nurse.

In my intern year, I put in very few IVs. It is a point of weakness for me now that I'm in the OR. On top of that I have to assert myself pretty early in the day otherwise my attending will steal my chance to put one in and throw in a 2nd IV when I'm taping in the tube.

It's amusing to me that I have had far greater success with art lines and central lines and I have done many more of both of them than I have done IVs.

Those that suggested we do them pre-op, for whatever reason our pre-op nurses are extremely territorial about this and get very upset when anesthesia residents try to put in the IVs in pre-op. I have only ever seen them refuse when someone offers to put in the IV in order to accelerate the process.

 

[Psai]

I was doing medicine at the VA a few months ago and never got call for IVs and never drew blood. If it was outside the 7-3, it was done by the patient's nurse.

In my intern year, I put in very few IVs. It is a point of weakness for me now that I'm in the OR. On top of that I have to assert myself pretty early in the day otherwise my attending will steal my chance to put one in and throw in a 2nd IV when I'm taping in the tube.

It's amusing to me that I have had far greater success with art lines and central lines and I have done many more of both of them than I have done IVs.

Those that suggested we do them pre-op, for whatever reason our pre-op nurses are extremely territorial about this and get very upset when anesthesia residents try to put in the IVs in pre-op. I have only ever seen them refuse when someone offers to put in the IV in order to accelerate the process.

Elective central lines are very easy. The target is huge, it's almost impossible to miss. A lines have a steep learning curve but they're pretty straightforward once you can hit the artery reliably.

IVs on npo for 8 hour patients are not easy. Especially with the frail old ladies that we seem to see in the ORs all the time. It's a lot easier to do when they're under anesthesia since they're vasodilated. The vein that might have only taken a 22 will accept an 18 easily.

You're a doctor. Act like it. You have things you need to do that are more important than finding out whether or not the patient has been to west africa and what their preferred pronoun is.

 

[anbuitachi]

Elective central lines are very easy. The target is huge, it's almost impossible to miss. A lines have a steep learning curve but they're pretty straightforward once you can hit the artery reliably.

IVs on npo for 8 hour patients are not easy. Especially with the frail old ladies that we seem to see in the ORs all the time. It's a lot easier to do when they're under anesthesia since they're vasodilated. The vein that might have only taken a 22 will accept an 18 easily.

You're a doctor. Act like it. You have things you need to do that are more important than finding out whether or not the patient has been to west africa and what their preferred pronoun is.

I mean if you use ultrasound for A line they are just as easy too if not easier.

IVs can be very challenging. I get almost all my IVs on first try at my primary institution. When i rotated thru a different hospital that used completely different IV starting kids, i blew all the IVs. The feel is 100% completely different .

 

[IMGASMD]

You're a doctor. Act like it. You have things you need to do that are more important than finding out whether or not the patient has been to west africa and what their preferred pronoun is.

Jack, is that you?! JK.
The EMR we use, just recently got an update. And its function is precisely this. What the patient preferred pronoun and name. I would not be surprised in six month, patients preferred name becomes part of TO.

 

[MaximusD]

I don't know how they do it in the US, but if an intern didn't know how to take blood at the start of the year they'd get ripped into. If they didn't know how to do it near the end, they'd fail internship.

Get to work early and do your own phlebotomy rounds or something.

Yawn, plenty of interns don’t know how to draw blood.

My recommendation is to do an elective in anesthesia and spend a few days ONLY PLACING IVs in pre-op. If you can place an IV, you can draw blood. Not rocket science, just experience and feel.

 

[deleted697535]

Honestly, I've only drawn blood a few times in 3rd year of med school. So i really don't know when I can draw blood from an IV or not, which tube top means what, etc.

Drawing blood is fairly easy. Stick the sharp end of a needle into something that looks bluey/green and pull back on the plunger

 

[GA8314]

Hey friends,

So I'm finishing up my intern year in internal medicine. I understand we have a lot of anesthesiology to learn... but what about the nuts and bolts of the nursing duties we also do that we don't learn in med school/intern year? Like I have no idea how to draw blood, set up IV pumps, etc.. What are some of those type of skills that we should know before starting?

Thanks!

You learn that stuff very quickly. We went over that stuff the first few weeks or so. It's not hard.