Saturday, January 9, 2010

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,



Grumpy, M.D. said...

Failure to follow these friendly guidelines will result in your gonads being served in a cafeteria omelet.

Pie said...

Ahahahaha that's hilarious. I'm student nurse in UK, but most of it's the same for the junior drs (F1+F2). Thank you for that, made me laugh so much! Rhiannon x

StorytellERdoc said...

Maha, great post! Where I work, I am on faculty for our ER residency and every single point you make has been covered at one time or another with our residents. But talented you nailed them in a great list...good job. It all comes down to communication, doesn't it? And if a resident comes in on a pedestal, he's pretty much marked for the four years! Too bad...

Have a great weekend.

DreamingTree said...

Outstanding! This should be required reading. :-)

ERP said...

I like the term "doclings".

Albinoblackbear said...

Yes, yes, yes, yes and yes. To all of the points in your post. Very well put.

If I may, I'd also like to add a couple...

9.b) don't be afraid to say 'I don't know' or ask for help when you are in over your head. Acting like a cowboy, pretending you know everything, and being perma-cavalier does not make you look like a confident, brilliant doctor. Nay, it makes you look like a tit. And people won't trust you. Strangely, if you admit you don't know something or if you *ask* a question the nurses will actually respect you more for being human and honest. We don't expect you to know everything. This isn't medical school.

11) Don't try and ply us with TimBits. If you're going to bring food make it HIGH quality (individually wrapped to avoid MRSA contamination) chocolate or savory delights.

If Crazy Carl is acting up and you are writing the haldol order, don't make it for 2.5mg PO PRN if Seroquel 20mg PO doesn't work. We'd rather give Carl a cup of (more effective) chamomile tea than wrestle him to the ground for the seroquel he doesn't want to take. Maybe even throw in a little ativan IM both for him and us. :-)

Doctor D said...

Doctor's order:

"Nurse Maha may administer treatment until patient becomes better and then discharge patient from the ER."

What can I say? I value your judgment.

I agree with ERP. "Doclings" is a wonderful neologism.

Maha said...

Dr. G - something tells me gonad omelet has probably been served recently.

Pie, Dreaming Tree and StorytellERdoc - glad my post managed to amuse as well as educate :P

ABB - I especially like rule 11 and the addendum added for Crazy Carl. Very befitting.

Dr. D - you write that now, but my judgment becomes increasingly warped as the shift goes on. In more desperate moments, i've considered throwing holy water at some difficult families!

Anonymous said...

Maha... you make me so glad I'm now working in a nonteaching hospital out in the 'burbs.

The VS thing always annoyed me too.

I've seen the "Stat warm blanket" and order too. I'll get right on that,and the blanket warmer is just down the hall. And don't be writing stat orders unless your patient is in imminent danger of death. In the emerg,this leads to "stat stat" and "superstat" and other silliness.

Anonymous said...

I just discovered your blog via a link from another blog, and I'm looking forward to reading your posts. As a resident (in Canada!) I appreciate your list. Common sense and respect for co-workers can go a long way!

I am concerned about Albinoblackbear's item 11 though. What do you think the resident's intention was, bringing in those TimBits? Could s/he have been simply bringing in some munchies for the shift, and sharing with you? Or reciprocating for the chips s/he ate on the previous shift? Wait until you are a resident... will you be able to afford (the money and the time) to bring in box of high-quality individually-wrapped box of gourmet chocolates to each shift?
- Canadian resident

NewgradRN said...

Amen to number 7. I confess that as a new grad nurse only a couple of weeks ago I misplaced 2 end of bed charts and completeley forgot about them until I found out where the other staff found them. *blushes* you can bet I won't be doing that again!! and no its not fun.