working as nurse

[peehdee]

Anyone know if medical residents can work as 'nurses'? I realize many docs don't want to clean up pt's '****', but nurses make a good more money than residents at least per hours worked.

So anyone know if medicine residents can 'moonlight' as nurses? I realize that you have to be a registered nurse to work as an RN but doesn't a medical resident have enough knowledge to work as a nurse if he/she is willing to put up with taking orders from interns? learning how to use the medical system or taking vitals can be quickly picked up.

Most residents can't legally moonlight in medicine/ER until their 3rd year cause most states require 2 years of post graduate training. Therefore you're stuck. It doesn't matter how much you work you still get the same amount of money. I can't think of any job outside the hospital that a med school graduate is qualified to do that would pay more than $10 an hour. Bartending is not an option as the hours are long and most won't hire you to work PRN.

Any comments? Please don't post, 'gee why would you want to wipe people's a**?', or 'why can't you live off a resident salary, live within your means!' type of comments. Only useful comments welcome.

Thanks

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[Winged Scapula]

You need a nursing license which you will not get because you haven't had the appropriate training. While you might be able to "pick it up" there is an awful lot about nursing that we don't learn during medical school.

 

[Blade28]

Be careful here...this thread has the potential of degenerating just like the "why can't MDs be PAs" thread.

 

[Tired]

Be careful here...this thread has the potential of degenerating just like the "why can't MDs be PAs" thread.

Wait . . . why can't MDs be PAs?

 

[Smurfette]

MDs cannot function as RNs because they don't have the same type of training. MDs generally do not know compatibility and duration of IV meds, timing of medications (depending on patient issue/other meds administered) or have such things as pharmacy access to medications, the same supply access, etc. Even such things as managing IV pumps and PCA pumps are not commonly done by MDs.

 

[Tired]

I can't think of any job outside the hospital that a med school graduate is qualified to do that would pay more than $10 an hour. Bartending is not an option as the hours are long and most won't hire you to work PRN.

Or you could, you know, moonlight as a doctor.

 

[BSN2DOC]

Anyone know if medical residents can work as 'nurses'? I realize many docs don't want to clean up pt's '****', but nurses make a good more money than residents at least per hours worked.

So anyone know if medicine residents can 'moonlight' as nurses? I realize that you have to be a registered nurse to work as an RN but doesn't a medical resident have enough knowledge to work as a nurse if he/she is willing to put up with taking orders from interns? learning how to use the medical system or taking vitals can be quickly picked up.

Most residents can't legally moonlight in medicine/ER until their 3rd year cause most states require 2 years of post graduate training. Therefore you're stuck. It doesn't matter how much you work you still get the same amount of money. I can't think of any job outside the hospital that a med school graduate is qualified to do that would pay more than $10 an hour. Bartending is not an option as the hours are long and most won't hire you to work PRN.

Any comments? Please don't post, 'gee why would you want to wipe people's a**?', or 'why can't you live off a resident salary, live within your means!' type of comments. Only useful comments welcome.

Thanks

Ummm... sorry to break it to ya... but I have never picked up **** before. RN's scope of practice is more than cleaning up a patient -- take a look at a state board of nursing website to look at an RN's duties/responsibilities.

 

[Pir8DeacDoc]

uninformed would be an understatement on this thread.


I'm not even going to speak to your total ignorance about just exactly what nurses do day in and day out. Is it "harder" that what we as residents do? Probably not, but it is definitely "different" than what we do.


You should clarify your states GME requirements for licensure. Many states only require one year. See if a nearby/neighboring state has a one year requirement. It might take a few hour drive but if you work a weekend shift in an ED or Urgent Care it would pay handsomely and make the drive worthwhile.

 

[doc02]

MDs cannot function as RNs because they don't have the same type of training. MDs generally do not know compatibility and duration of IV meds, timing of medications (depending on patient issue/other meds administered) or have such things as pharmacy access to medications, the same supply access, etc. Even such things as managing IV pumps and PCA pumps are not commonly done by MDs.

Um, what? Nurses know this stuff? I've never seen a nurse figure out the "compatibility and duration" of any medication. I'm being serious here. Or going, "wow, we can't give x drug right now because we just gave y drug and it diminishes the bioavailability, but if we administer the first one and then stagger the second one by five-hour incrementals ..." If anyone knows of this actually occurring, tell us about it. Nurses may know stuff like how meds are mixed (like if you order a drip, they can tell you how to order it, like what IVF it's mixed with and what concentration is standard), but that's about it.

 

[Top Gun]

Anyone know if medical residents can work as 'nurses'? I realize many docs don't want to clean up pt's '****', but nurses make a good more money than residents at least per hours worked.

So anyone know if medicine residents can 'moonlight' as nurses? I realize that you have to be a registered nurse to work as an RN but doesn't a medical resident have enough knowledge to work as a nurse if he/she is willing to put up with taking orders from interns? learning how to use the medical system or taking vitals can be quickly picked up.

Most residents can't legally moonlight in medicine/ER until their 3rd year cause most states require 2 years of post graduate training. Therefore you're stuck. It doesn't matter how much you work you still get the same amount of money. I can't think of any job outside the hospital that a med school graduate is qualified to do that would pay more than $10 an hour. Bartending is not an option as the hours are long and most won't hire you to work PRN.

Any comments? Please don't post, 'gee why would you want to wipe people's a**?', or 'why can't you live off a resident salary, live within your means!' type of comments. Only useful comments welcome.

Thanks

After getting your MD and getting into a residency, why would you want to work as a nurse? In the first place, you're already working long hours as a resident. Second, why did you go to all the trouble of getting an MD if you still want to work as a nurse? At some point, you've got to decide on a career and commit to it. If you're going to moonlight, moonlight as a doctor instead. The pay is even better than what you would get if you moonlighted as a nurse.

 

[docB]

Um, what? Nurses know this stuff? I've never seen a nurse figure out the "compatibility and duration" of any medication. I'm being serious here. Or going, "wow, we can't give x drug right now because we just gave y drug and it diminishes the bioavailability, but if we administer the first one and then stagger the second one by five-hour incrementals ..." If anyone knows of this actually occurring, tell us about it. Nurses may know stuff like how meds are mixed (like if you order a drip, they can tell you how to order it, like what IVF it's mixed with and what concentration is standard), but that's about it.

Nurses I work with frequently (ie. several times a day if not an hour) deal with medication issues like compatibility, route of admin and so on. If you've ever seen bicarb cause something to precipitate out in a line you'll want to avoid it. Nurses where I am (stroke center/ PCI chest pain center) know how to dose the TPA for stroke and the TNK for AMI. They're different and you don't want to screw it up.

Nursing is not an easy or brainless job. Good nurses are very valuable and can save your ass. Bad nurses stick out like a sore thumb. In my experience it's easier to hide your incompetence as a bad doctor than a bad nurse.

I view nursing as the field devoted to care delivery. Nurses know how to get the meds into the patient, how to deal with the logistics of meds, drips, lines, studies, procedures, etc. Nurses are more likely to be the ones assessing if therapies are working or not and what patient’s pain levels are.

 

[jessica84]

Nurses I work with frequently (ie. several times a day if not an hour) deal with medication issues like compatibility, route of admin and so on. If you've ever seen bicarb cause something to precipitate out in a line you'll want to avoid it. Nurses where I am (stroke center/ PCI chest pain center) know how to dose the TPA for stroke and the TNK for AMI. They're different and you don't want to screw it up.

Nursing is not an easy or brainless job. Good nurses are very valuable and can save your ass. Bad nurses stick out like a sore thumb. In my experience it's easier to hide your incompetence as a bad doctor than a bad nurse.

I view nursing as the field devoted to care delivery. Nurses know how to get the meds into the patient, how to deal with the logistics of meds, drips, lines, studies, procedures, etc. Nurses are more likely to be the ones assessing if therapies are working or not and what patient’s pain levels are.

Thank you. To address Doc02's comment that nurses do not need to know if drugs are compatible, yes we absolutely need to know that. It's not even just meds. forming incompatibilities. It's also the IV solution the patient is on. Precipitates can form among the medication and IV solutions too. Some can't mix with a dextrose solution; others can't mix with a saline solution. We also must be aware of the potential reactions patients may have when the IV infusion rate is increased in the doctor's order and know how to handle the reaction. We have to monitor the patients, knowing which side effects to look for as well as how to evaluate the patient to see if the drug is effectively working.

Do I give meds. not knowing why I'm giving them, if the dose is appropriate, how to effectively monitor my patient, and not knowing a thing or two about their compatiblity? No. I would be extremely uncomfortable doing that. I'm still a student, so believe me, I still have a lot of learning to do and am constantly looking up drugs while on the floor. Do doctors ever make mistakes calculating a dose or giving two incompatible drugs together after going three weeks with little to no sleep? Yes, and nurses should be double-checking the dose to make sure it's in a therapeutic range (not to say that there aren't exceptions for certain patients), looking for incompatibilities. etc. The nurse I worked with the other day happened to catch a doc's mistake, and the doc was thankful for it. Did the nurse jump in his face? No. She just questioned the order (after seeing the dose), and he realized he wrote down the wrong number. We all make mistakes, and unfortunately, in this business, the costs can be deadly. That's why we all should have a strong knowledge and support each other (unless I'm just living in my own world), isn't it true? It's for everyone's benefit including our patients.

No, we may not be prescribing the drugs to the patients, but there is a lot more involved than some may think.

 

[doc02]

Oh, if you guys want to count that, fine. But most interns and residents know what drugs you need to run through what line and what precipitates what out, too, within a few months (even if it was because a nurse told them). There aren't a lot medications that this is a problem for on a routine basis, either (I'd say probably less than five). To say that nurses are "frequently" assessing this is quite an exaggeration, in my opinion. Patients can be on ten to fifteen medications at a time easily without any problem in terms of route of administration or IV meds reacting with each other.

Most of what nurses do is juggle GIVING the medications. So, yeah, if a patient is on multiple IV medications, they can figure out the best way to give them in the shortest time. But even then, that rarely is an issue because except for ICU patients people aren't generally on so many medications that are timed that you need to actually do this. You can just run in one and then the other.

 

[Tired]

Oh, if you guys want to count that, fine. But most interns and residents know what drugs you need to run through what line and what precipitates what out, too, within a few months (even if it was because a nurse told them).

Acually, I don't have a clue about stuff like that. That's why God made nurses: so I can scribble out what I want given and they can figure out how to get it done.

 

[doc02]

I wish I could do that.

 

[mdjobexchange]

I did medical transcription during medical school and made upwards of 30 bucks an hour doing that. If you can type, that might be an option. Nice thing is, you can do it whenever you want. I had a key to the office and could show up whenever I wanted, bang out 3 or 4 hours of transcription and go home.

It was OK work, sometimes humorous hearing how bad some people were.

Some pathology labs pay pathology residents to "cut-in" specimens for them. Pay is pretty good, you just would have to learn how to do it. It is not that terribly hard. Take some representative sections, put it in the cassette, label it, and move on.

Could also try tutoring college/medical students for organic chemistry, anatomy, or whatever. I knew some people who did that.

 

[Faebinder]

With the risk of hijacking... I think we all agree that an MD doesn't make you eligable to work as a nurse, you still need some formal training (no, no one is necessarily claiming an MD requires scientific training...) On the other hand, you definitely can argue that you should be able to work as a PA.

Unfortunately, the license system is state based and states rules are controlled by their medical boards and we all know how physicians eat their young for the sake of "better" healthcare. My guess they wont allow MDs to moonlight straight out of med school at their own risk because they are afraid of an invasion of foreign docs trying to work in the US and using the "need for docs" to justify their presence. But the tolerance to that varies from state to state. But again we go back to physicians eating their own young (for example... AMG needs 2 years in Pennsylvannia, IMG needs 3 years and the DO needs 1 year.... Heh so is the allopath in the residency with the DO is less trained and shouldn't moonlight?!? And the FMG is even less qualified?)

 

[hermit]

Since we're on the subject, could someone take a minute to clarify how "moonlighting" (for MDs) works? Am I to understand that after one or two years of residency (depending on the state), I can go get a job as a doctor in my off time making decent money? Is there a catch like, "Sure, but there is no off time for residents!"

 

[peehdee]

Or you could, you know, moonlight as a doctor.

ah, you didn't read the post closely. most states require 2 years of post graduate training before you can get an unrestricted license, which is require for residents to moonlight. so essentially you have to be a PGY3 to do that. so any PGY1 or 2 can't moonlight. nb in delaware one can get unrestricted license after one year of post graduate training and hence moonlight.

 

[peehdee]

After getting your MD and getting into a residency, why would you want to work as a nurse? In the first place, you're already working long hours as a resident. Second, why did you go to all the trouble of getting an MD if you still want to work as a nurse? At some point, you've got to decide on a career and commit to it. If you're going to moonlight, moonlight as a doctor instead. The pay is even better than what you would get if you moonlighted as a nurse.

you're not getting the question here. i need $$$ intern salary is horrible especially with a kid to raise. those of you who are single can afford to live on dirt but not when you have a kid. and i didn't say i wanted to work as a nurse forever. nurses make decent money. as a medical resident you can't really work anywhere else cause we're not qualified plus the Q4 calls means you can't get a job where you can work every monday, wednesday, friday night (for example) thus most places would have to adjust to YOUR schedule. i guess i figure it would be easier to work as nurse cause we give orders about management all the time. they monitor vitals, enter orders, clean up, hang iv, give meds on a schedule page the resident with any questions (all of which i can do at this point in my training). if there was a job out there that would pay you 15 to 20 dollars an hour, be a PRN or per diem position and didn't require that i get a 'technical training' or be 'certified' in some way i would do it. but i can't think of any jobs like that.

disclaimer: i'm not saying that getting a nursing degree is easy in it self but for someone who finished medical school, i don't think it would be imposisble to learn

 

[peehdee]

Since we're on the subject, could someone take a minute to clarify how "moonlighting" (for MDs) works? Am I to understand that after one or two years of residency (depending on the state), I can go get a job as a doctor in my off time making decent money? Is there a catch like, "Sure, but there is no off time for residents!"

basically you need a state license to practice medicine. when you're a resident that license is issued via your residency program. so you can write for stuff like percocet and other controlled substances while working in that particular hospital, but you can't write it for outside hospital (i.e. scripts for percocet). also, your liability insurance is covered by your program. that being said. most states require 2 years of post graduate training for MDs (i think the DO might be less i'm not sure) to apply for unrestricted license (meaning you CAN write the percocet for example). once you have that you can 'practice' medicine on your own, if you wish. you can diagnose and charge people. but the catch is that most insurance companies won't pay for someone who did not finish a residency (3 years of internist). plus a lot of hospitals probably won't hire someone who is not board eligible (i.e. finished a residency). thus, just finish the darn third year and get board certified.

that being said, there are 2 ways to moonlight during residency.
1) alot of smaller programs have internal moonlighting. for example working in the ER or doing the initial admission orders and physicals for in patients. you can do this because your own institutions liability insurance covers you cause you're working in their hospital. the pay is not usually that good $45 to 50 and hour? remember the 80 hour rule applies here. thus you'd have to work 70 hours on your regular schedule to squeeze a 10 hour moonlight to stay under80. at $50 an hour you can make $500 a week EXTRA.

2) moonlight outside your own hospital. this means you pay for your own malpractice insurance and gets alot more involved. it pays i think a little bit more than in your own institution but probably harder to find.

a lot of programs won't let their residents moonlight in house (especially university programs) but they can't really say much outside the hospital (i.e. when you're on your own time). with the 80 hour limit, people can actually moonlight now. what you do outside the hospital is your own. for example you can work at mcdonalds if you wanted to (as long as you meet your duties at your residency). of course most ppl won't need to 'work outside' cause they don't need that extra money. from an education point of view, you can learn alot moonlighting cause you're making decisions.

Of course after you're done with residency you can still pick up extra hours moonlighting to make some extra bucks. its pretty nice if you think about it. but when you're PGY 1 or 2 you're screwed cause you can't really moonlight cause of the license thing. some PAs admit in patients in the ED just like residents (they talk directly with attending doc) but for some reason they won't let PGY2s (who know how to do h & p and admit patients) earn the same dollar as PAs. i guess they figure you should be spending your time learning and not looking for the $$.

hope that helps.

 

[Blade28]

Don't forget that in surgical residencies, moonlighting is usually only an option during your lab (research) years - not only is there no time to moonlight during your clinical years, but most program directors won't allow it.

 

[hermit]

hope that helps.

Very much so! Thanks!

 

[telenurse]

I would definitely stick with a medical moonlighting if I were you.
The stickiest matter would be that to recieve Licensure to work as a nurse, you would have to apply to the state Board of nursing in the state you reside in. Each state has similar requirments, including successful competion of an accredited nursing school. I don't think passing the NCLEX would be a problem on the pure knowledge part...but it might be difficult with the critical thinking, because you would have to critically think like a nurse, not a doctor.
In all honesty...I think it would be easier for an intelligent nurse to become a doctor than for a doctor to become a nurse. For one...how could you stop yourself from practicing medicine when you know time is of the essence?? Sometimes in an emergency it really sucks being ACLS trained and being a nurse, I know the algorhythms, I know the meds... I can have them pulled out and ready, but I can't give them without an order. Put yourself in that place.

 

[doctobe2]

you're not getting the question here. i need $$$ intern salary is horrible especially with a kid to raise. those of you who are single can afford to live on dirt but not when you have a kid. and i didn't say i wanted to work as a nurse forever. nurses make decent money. as a medical resident you can't really work anywhere else cause we're not qualified plus the Q4 calls means you can't get a job where you can work every monday, wednesday, friday night (for example) thus most places would have to adjust to YOUR schedule. i guess i figure it would be easier to work as nurse cause we give orders about management all the time. they monitor vitals, enter orders, clean up, hang iv, give meds on a schedule page the resident with any questions (all of which i can do at this point in my training). if there was a job out there that would pay you 15 to 20 dollars an hour, be a PRN or per diem position and didn't require that i get a 'technical training' or be 'certified' in some way i would do it. but i can't think of any jobs like that.

disclaimer: i'm not saying that getting a nursing degree is easy in it self but for someone who finished medical school, i don't think it would be imposisble to learn

I beg to differ-"easier"- ask any nurse after an 8 hour shift- No! it is not easier to be a nurse.

 

[MacGyver]

Oh come on I work with nurses every day and know what they do and dont do.

I could learn what a regular ward RN needs to do 95% of her daily job after about 2 days of intensive training.

 

[San_Juan_Sun]

I beg to differ-"easier"- ask any nurse after an 8 hour shift- No! it is not easier to be a nurse.

No disrespect to nurses, but an 8 hour shift is a joke. I can do anything for 8 hours with a smile on my face. If I, as a resident, worked 8 hour shifts I'd be home at noon every day.

There's a lot of people in this country that work a lot more than 3 12s, or 4 8s, or whatever allied health folks work. Try digging ditches for a while, working 70 hours a week (I have). Try 30 hours on call. Don't tell me how hard an 8 hour shift is. Been there, done that.

 

[Faebinder]

No disrespect to nurses, but an 8 hour shift is a joke. I can do anything for 8 hours with a smile on my face. If I, as a resident, worked 8 hour shifts I'd be home at noon every day.

There's a lot of people in this country that work a lot more than 3 12s, or 4 8s, or whatever allied health folks work. Try digging ditches for a while, working 70 hours a week (I have). Try 30 hours on call. Don't tell me how hard an 8 hour shift is. Been there, done that.

Exactly... the days that I go home after 8 hours of work.. I'm actually feeling odd and I feel like I am going home early.... and am grateful too... Isnt that just sad?

 

[Mman]

A friend of mine in medical school had been an RN for years. He moonlighted as an RN while in medical school to make extra cash and he got paid quite well for working some crazy 24 nursing shifts.

There is no chance that a resident (PGY anything) could moonlight as a nurse from a legal point of view so it's not worth worrying about.

 

[DebDynamite]

I am glad this thread was created as it has given me some ideas...

The OP cannot work as a nurse due to ( I'm pretty sure) thefact that they have no nursing training on paper. Ie- credits from a nursing program which would allow them to then sit for the NCLEX and obtain nursing credentials. But maybe you could take a phlebotomy course, or try the dictation route? Both require a lot cheaper and easier training.

I received my BA in humanities in '97, & went back to nursing school (for second degree) from 99-2001. I promise you that if you can pass USMLE's there is absolutely NO need whatsoever to even consider studying for the NCLEX- I swear. The entire NCLEX would feel to you like 1/2 (one very easy half) of a single block of USMLE step 2CK. That said, while I'm sitting here in my fourth year of med school, I should see what I might need to do to actually obtain liscensure, because you are right- it would be a good way to make money on the side. Also, it's sad but true that most nursing schools, the ones that dole out the BSN's, don't really give you the (amount of) hands-on training the way it should be done. Most of the practical learning takes place on the job right out of school. So, while I think the OP's idea is actually good, it just won't work. Besides, as a previous poster has pointed out already, you would be really, really frustrated. But your interns would love you because would probably page them less.

 

[Tired]

ah, you didn't read the post closely. most states require 2 years of post graduate training before you can get an unrestricted license, which is require for residents to moonlight. so essentially you have to be a PGY3 to do that. so any PGY1 or 2 can't moonlight. nb in delaware one can get unrestricted license after one year of post graduate training and hence moonlight.

Actually most require 1 year of post-graduate training, unless you're an IMG.

http://www.fsmb.org/usmle_eliinitial.html

I hadn't realized you were an intern. I'm impressed that you have the extra time to work. The majority of my rotations require on the order of 80-90hrs a week, on average.

 

[swpm]

Nurses may know stuff like how meds are mixed (like if you order a drip, they can tell you how to order it, like what IVF it's mixed with and what concentration is standard), but that's about it.

Near as I can tell, the only thing our ICU nurses do when I order a drip is walk the order sheet over to the fax machine, place it in the tray face up, hit the button with "PHAMACY" Sharpie'd on it, and wait for some pharmacy tech to mix up the drug and tube it to the ICU. Hopefully, the bag won't sit in the tube unnoticed for very long before it gets hung on a pole and plugged into the IV I had to start for them because the patient was a tough stick. Whew, time for a coffee break, I've been working almost 8 hours today!

Nurses do a lot of things I don't want to do, and for that I'm grateful. But I'm also sick of hearing about their "specialized skill set" and how hard they work.

 

[doc02]

Near as I can tell, the only thing our ICU nurses do when I order a drip is walk the order sheet over to the fax machine, place it in the tray face up, hit the button with "PHAMACY" Sharpie'd on it, and wait for some pharmacy tech to mix up the drug and tube it to the ICU. Hopefully, the bag won't sit in the tube unnoticed for very long before it gets hung on a pole and plugged into the IV I had to start for them because the patient was a tough stick. Whew, time for a coffee break, I've been working almost 8 hours today!

Stop lying like that. The coffee break comes way before 8 hours.

 

[telenurse]

Near as I can tell, the only thing our ICU nurses do when I order a drip is walk the order sheet over to the fax machine, place it in the tray face up, hit the button with "PHAMACY" Sharpie'd on it, and wait for some pharmacy tech to mix up the drug and tube it to the ICU. Hopefully, the bag won't sit in the tube unnoticed for very long before it gets hung on a pole and plugged into the IV I had to start for them because the patient was a tough stick. Whew, time for a coffee break, I've been working almost 8 hours today!

Nurses do a lot of things I don't want to do, and for that I'm grateful. But I'm also sick of hearing about their "specialized skill set" and how hard they work.

I can't believe that the ICU asked a doctor to start an IV

I've never asked a doctor to start an IV...I'm usually pretty good, if I can't get it, and my buddy can't, I ask someone to come over from peds, if they can't get it, I call the resident, and by that point the pt usually buys a femoral line. Now I have started IV's in the thumb, the lower palm, the shoulder, and one time a breast (it was an emergency, I just blurted out, I see one in the breast, the res said go for it, got flashback, so we used it)

Nurses aren't allowed to mix drips anymore according to JCAHO, I think we can in a code situation but that's it.

I can't really comment much on ICU nursing other than it's much different than the floor...I can't imagine only having 2 pts...albeit 2 very sick pt's on vents...

 

[swpm]

I can't believe that the ICU asked a doctor to start an IV

Wow, I get accosted for IV starting services once or twice each week (and that's not counting the anesthesia duty pager hits I get on call). It's less common in ICU or step down, rare in the PICU. Then again, I'm an anesthesia resident and a very nice guy (despite my online 50/50 mix of snark and sarcasm), so perhaps I invite IV turfing more than others. I walk down hallways and nurses will ask me if I have a few minutes to draw some blood on a patient who's a tough stick.

Nurses aren't allowed to mix drips anymore according to JCAHO, I think we can in a code situation but that's it.

The thing that frustrates me the most about ordering drips in the ICU, is that I'm afraid by the time the nurse gets the drip hung, the patient very well may be coding. The delays are absurd. This is JCAHO's fault, perhaps, but more than once I've had to run to the anesthesia supply room next to the ICU/OR, get drugs, and mix up a drip myself because the patient's hanging out at 60/30 while some pimpled pharmacy tech trainee waits for a convenient time to put his DVD on pause. And at that point, the icing on the cake is that the nurses get pissy if I touch their infusion pumps, and they insist I write orders first and hand off the bags to them.

I don't know how the other residents (who don't mix drugs daily like we gas types do) manage these situations. Stand next to the code cart, staring at the monitor and the second hand on the clock? Desperately hope the pharmacy tubes up the drip before they need to break out the epi? Automatically use dopamine for everything because it's in premixed bags?

Sorry, now I've derailed my nurse-appreciation-rant derailment into a how-the-hospital-obstructs-care derailment. I'll stop now.

 

[Faebinder]

Wow, I get accosted for IV starting services once or twice each week (and that's not counting the anesthesia duty pager hits I get on call). It's less common in ICU or step down, rare in the PICU. Then again, I'm an anesthesia resident and a very nice guy (despite my online 50/50 mix of snark and sarcasm), so perhaps I invite IV turfing more than others. I walk down hallways and nurses will ask me if I have a few minutes to draw some blood on a patient who's a tough stick.



The thing that frustrates me the most about ordering drips in the ICU, is that I'm afraid by the time the nurse gets the drip hung, the patient very well may be coding. The delays are absurd. This is JCAHO's fault, perhaps, but more than once I've had to run to the anesthesia supply room next to the ICU/OR, get drugs, and mix up a drip myself because the patient's hanging out at 60/30 while some pimpled pharmacy tech trainee waits for a convenient time to put his DVD on pause. And at that point, the icing on the cake is that the nurses get pissy if I touch their infusion pumps, and they insist I write orders first and hand off the bags to them.

I don't know how the other residents (who don't mix drugs daily like we gas types do) manage these situations. Stand next to the code cart, staring at the monitor and the second hand on the clock? Desperately hope the pharmacy tubes up the drip before they need to break out the epi? Automatically use dopamine for everything because it's in premixed bags?

Sorry, now I've derailed my nurse-appreciation-rant derailment into a how-the-hospital-obstructs-care derailment. I'll stop now.

I have been asked to start a central line several times and they didnt even attempt an IV... I go in and put a peripheral and all is done... A lot of time it's their way of being passive aggressive for getting a sh**ty admission (like a dying patient that needs a lot of work and attention, like it's my fault). When you think about it, it's rather sad because they are supposed to care, but I toss it off to "everyone has bad days".

I'm a firm believer that the med students should also be attempting more peripheral IVs... but that's another story.

 

[peehdee]

Actually most require 1 year of post-graduate training, unless you're an IMG.

http://www.fsmb.org/usmle_eliinitial.html

I hadn't realized you were an intern. I'm impressed that you have the extra time to work. The majority of my rotations require on the order of 80-90hrs a week, on average.

- that link that you sent is out dated to some extent, i.e. in NJ you need two years of PGY and be in a 3rd year of program before you can apply for license (anyone who graduated med school after 2003).

- what i don't understand is why in general DOs have less years of requirement than the MDs.

- as for the time thing, i'm a transitional resident so..

- and the weeks that i'm on the medicine floor i average maybe 65 hr a week?

 

[jessica84]

I'm a firm believer that the med students should also be attempting more peripheral IVs... but that's another story.

I think giving IV's is something that some learn easily, and some take longer to learn (for both nurses, med. students, and even some residents whom I have observed struggle). Some may laugh, but I would say that practice, if possible, should be done on one of those "fake arms" or on a patient under general anesthesia (like during surgical rotations). (I don't know if all med. students have that though. ) I've seen too many hospital workers poke at patients (in and out in so many different locations) and just not getting it (while making the patient miserable.) I have clinicals at a pediatric hospital, so it's even more of an issue. I was fortunate enough to be able to start an IV on a nurse who said I could try on her before attempting my first patient. Surprisingly, (I say that because I was a little concerned with giving my first IV ever), it wasn't very difficult and went right in. (I guess the practice on the "fake" arm with the extra thick fake skin worked. They're ridiculous-looking, but good practice.) I saw a med. student give a peripheral IV at a 90 degree angle in the operating room. The next time, he almost can poked the needle right back of of the skin.Yikes. At least the patient was under anesthesia. (I felt bad for him. He seemed really flustered. His instructor thought he was taught how to give IVs, and apparently he wasn't.)

 

[jessica84]

Stop lying like that. The coffee break comes way before 8 hours.

You know, I really hate those generalizations for nurses, because I know I'm the complete opposite, but I've got to laugh. I've been transferred to different floors during my clinical rotation, and there is no kidding that some nurses work harder than others. You ask one nurse where to find something in the hospital (on your first day as a student), and she grumbles something incomprehensible while munching on pretzals and Mountain Dew. Me: "Oh, okay, carry on... with your snack."

I am amazed at some of the nurses who have the personality of a box of nails...and I wonder how they have gotten to where they are.

However, most I work with are great. I truly have worked with some excellent ones who are very intelligent, knowledgable, and you can see that they love what they do. They enjoy teaching students new procedures, etc. These nurses tend to take new students under their wing, providing wonderful teaching opportunities for me. At the pediatric hospital I am at, we have some superb nurses and doctors! Great people there.

And...while, there are some crappy nurses here and there, I've seen a couple of doctors who have no social skills too and cannot speak to nurses nor patients without acting like an a$$....

My conclusion? There are lazy, no good people in all careers...but if I sat and complained about them all day in threads, I think I would just start hating, well...everyone...really. That would just sour your attitude towards your job even more.

There are also highly intelligent people in both fields too. I must say if one particular person can't get along with a general group of people, profession, etc. anywhere...there is something further going on...

 

[telenurse]

The thing that frustrates me the most about ordering drips in the ICU, is that I'm afraid by the time the nurse gets the drip hung, the patient very well may be coding. The delays are absurd. This is JCAHO's fault, perhaps, but more than once I've had to run to the anesthesia supply room next to the ICU/OR, get drugs, and mix up a drip myself because the patient's hanging out at 60/30 while some pimpled pharmacy tech trainee waits for a convenient time to put his DVD on pause. And at that point, the icing on the cake is that the nurses get pissy if I touch their infusion pumps, and they insist I write orders first and hand off the bags to them.

quote]
Yeah...I had a really dedicated resident one time literally take off to the ICU, brave the nurses there for taking a drip out of their fridge where it was considered "stock", run back to my tele floor and hand it me so we could hang it on my pt, because pharmacy wasn't picking up the phone and didn't seem to understand that stat meant STAT!

Poor guy...the next time my floor had a potluck I made sure I invited him.

 

[Top Gun]

You know, I really hate those generalizations for nurses, because I know I'm the complete opposite, but I've got to laugh. I've been transferred to different floors during my clinical rotation, and there is no kidding that some nurses work harder than others. You ask one nurse where to find something in the hospital (on your first day as a student), and she grumbles something incomprehensible while munching on pretzals and Mountain Dew. Me: "Oh, okay, carry on... with your snack."

I am amazed at some of the nurses who have the personality of a box of nails...and I wonder how they have gotten to where they are.

However, most I work with are great. I truly have worked with some excellent ones who are very intelligent, knowledgable, and you can see that they love what they do. They enjoy teaching students new procedures, etc. These nurses tend to take new students under their wing, providing wonderful teaching opportunities for me. At the pediatric hospital I am at, we have some superb nurses and doctors! Great people there.

And...while, there are some crappy nurses here and there, I've seen a couple of doctors who have no social skills too and cannot speak to nurses nor patients without acting like an a$$....

My conclusion? There are lazy, no good people in all careers...but if I sat and complained about them all day in threads, I think I would just start hating, well...everyone...really. That would just sour your attitude towards your job even more.

There are also highly intelligent people in both fields too. I must say if one particular person can't get along with a general group of people, profession, etc. anywhere...there is something further going on...

Don't mind doc02. He's had too many negative experiences with the nurses at his hospital, so naturally he's bitter. I agree with you that there are good and bad doctors, and good and bad nurses.

 

[Tired]

You know, I really hate those generalizations for nurses, because I know I'm the complete opposite, but I've got to laugh. I've been transferred to different floors during my clinical rotation, and there is no kidding that some nurses work harder than others. You ask one nurse where to find something in the hospital (on your first day as a student), and she grumbles something incomprehensible while munching on pretzals and Mountain Dew. Me: "Oh, okay, carry on... with your snack."

Just stop already.

First of all, he didn't "generalize" about anyone. You cited his post, so I assume you read it. He made a joke in reference to an earlier story, implying that the nurse in the story took a lot of breaks.

Then you break in with "C'mon you guys, don't make generalizations!" followed by a story of your own about a nurse who takes a lot of breaks. This doesn't seem at all strange to you?

Je$u$ H Chri$t. If you're going to continue to make the same dull point over and over again ("Nurses aren't all the same! Some are good, and some are bad! I'm a good nurse, I promise!") at least pick an appropriate moment, when someone actually said something obnoxious.

 

[doc02]

I must say if one particular person can't get along with a general group of people, profession, etc. anywhere...there is something further going on...

There are lots of people who can't get along with each other. The only difference between me and them is I don't pretend that I love everyone when I don't. I can bet you dollars to doughnuts that if you could read everyone's minds, there would be a lot of deep and unabiding hatred going on between people, not sweetness and light. I guess you could say that pretending to get along is a "good trait." That would be your opinion and you're certainly entitled to it.

 

[swpm]

I'm a firm believer that the med students should also be attempting more peripheral IVs... but that's another story.

Absolutely ... but not on patients known to be difficult. The only thing worse than getting paged for an IV start at 2 AM is discovering that a med student has blown both antecubitals, both intern veins, and anything on the hands. Seriously, good on him for giving it a go, but now I'm reduced to caressing scabby armadillo skin diabetic ankles (yuck) or getting into the central line debate with some poor cross-cover intern.

I try to encourage med students to acquire their IV starting skills the old fashioned way: by abusing frequent-fliers in the ER and 20-year-olds with pipes under general anesthesia.

 

[Blade28]

I can bet you dollars to doughnuts that if you could read everyone's minds, there would be a lot of deep and unabiding hatred going on between people, not sweetness and light.

Ain't that the truth.

 

[doc02]

Everything I say is true (that's the law). Also, you don't know how many conversations I've heard from nurses where they think nobody can hear them and they're like, "those stupid residents" or "man, the attendings are idiots, I would have done this (insert nonsense)" or even "I can't believe those nurses on the sixth floors, they're so lazy!" Nurses generally despise most everyone in a hospital, from techs to nurses to residents to attendings. The fact that people think nurses are these sweet lil' ol' gals who are super sweet angels and that people who talk ill of them are just nasty folk is the most laughable thing I've ever heard.