Dear Residents

We have been working together for quite some time now and I hope you know that I’m your friend. I don’t mean that in a facetious or sarcastic way at all. I truly am your friend. I value your learning very much because one day you little doclings are going to grow up to treat me as well as my loved ones who are hovering around their 60s and beyond. I realize that despite all the orientations you will get from your seniors and attendings, navigating a unit, its protocols and its culture can be frustrating. Many of you turn to nurses to guide you through the noisy maze and while I can’t speak for every nurse, many of us are more than happy to help you through the process. Us nurses are also familiar with the attendings’ mood (swings) and their teaching styles so if for some reason you find that the head honcho is bitching at you for something mundane, we can probably guide you towards a safe exit. So in return I would greatly appreciate if you could please keep the following guidelines in mind:

1) Don’t page a nurse overhead stat to a patient’s room to deliver blankets and clean diapers. Especially if the nurse is another room doing a delicate procedure – like say, CPR.

2) Don’t order an esoteric combination of medications past the hour when the pharmacy closes down and we’re down to floor stock, especially when something simple would suffice. If you want to know whether or not a med is stocked, just ask!

3) If you sign up to see a patient, please ensure that you actually do see them. Patients tend to get irritated when they come to a hospital and are not assessed by a physician. They then take it out on the nurses, which makes everyone unhappy.

4) If a nurse is telling you that a licensed physician needs to administer a medication, writing “nurse may give ____” on the chart is not going to cut it. We all have our licenses to protect and we all like getting paid. It helps a lot with groceries and rent.

5) While we’re on the subject of writing appropriate orders, please do not write, “nurse may administer available narcotics until pain manageable”. I’m flattered that you value the nurses’ judgment so highly but narcotics are highly controlled substances which need clear orders to dispense. Also, see comment above about groceries and rent.

6) And yet another guideline for appropriate orders. If you’re in an area of the department in which patients are only brought into rooms for assessment, it is not appropriate to write, “patient may sleep in room”. If myself or another nurse actually followed that order, we would have our asses kicked from here to Australia and back with a steel toed boot for slowing down patient flow.

7) Please leave charts as you find them. As much as some of us might have liked scavenger hunts back in grade school, somehow the joy of hunting down a chart is just not the same thing.

8) If you’re in a patient’s room (especially one that is an isolation room), please do not ungown, wander the department and ask the nurse to obtain a set of vitals on the isolated patient. Patients who are isolated have their own fully stocked vital sign machines inside the room.

9) If you freeze up during your first code don’t feel bad. There are a lot of experienced nurses and doctors in the room. I guarantee everyone can sympathize. The sympathty ends however, if you start finger pointing and blaming.

10) Please and thank you always help when talking to anyone and everyone.

Follow these guidelines in any department on any rotation and I guarantee you’ll have a good (or at the very least, tolerable) relationship with the rest of the staff. I hope you enjoy your emergency rotation and if Crazy Carl is insisting that the key to survival lies in dismantling the IV pump, please order Haldol stat.

Your friend,

Maha