Ahh...the teaching hospital. A place where residents grow and blossom. Coming out fresh from school in July - they plunge head-on into the real hospital world of writing orders, dealing with crisis, and being completely responsible for his/her patients. It is a step into the unknown - they learn through trial and error, and hone their craft through the 2+ years of residency.
Rounds with the Attendings in the morning are a teaching moment for all. In the ICU I am able to hear all about pathologies, differentials, potential paths of care, and ultimately the logic and plan for my patient. I usually have an input and am typically seen as a resource in this process depending on who the Attending is. I am blunt and to the point. We have a limited number of repetitive Attendings; I am seen as a nuisance, a gatekeeper, a partner, and as a cute nurse who likes to get her way. Many times I am all of these at once. Usually I am a babysitter. I am babysitting the residents.
Many times a helpful prod or push will awaken them to the realization that I have been here for a couple years, I have seen this type of patient before, I know the Attending, I know this hospital, I have a fairly good ideas how the dots connect. I can make your job easier, and I can save you from looking like an idiot.
Sometimes they just are idiots, and I get an evil pleasure out of watching them drown. Horribly, I call a superior physician, to come and assess my patient. I would never let my patient suffer for negligence by someone who is incompetent, though I think many times the residents would rather see how the dice roll, than be held accountable for anything.
So instead of telling you what bad residents do (the list would be endless) - I will tell you what good residents are like and what good role models they can be.
A good resident is always attractive - even if they started out ugly, by the end of their residency they have the self-confidence, humility, critical thinking, and good judgment to be attractive to anyone. I mean this - men and women, bald and not. When they can run a code, ask you for things by your name, and remain cool - they are attractive.
A good doctor always checks in at the end of the day - I mean it. Post-call or not.
Always sits down (at least once) to talk to a family member. I mean literally sit.
Calls the family to give updates
Knows good nurses by name, says thank you to nurses who give exceptional care, and tells the patient they have a good nurse when they do. (I don't just mean this in a shallow good-nurse way. There is sometimes this weird animosity b/w doctors and nurses. The nurse wants power (even if it is bitchy power), the doctor wants recognition for his $100,000 debt, and they treat each other with contempt)Telling a patient he is being well taken care of is a renewing cycle. The patient is grateful and reassured, and the nurse thinks "I am a good nurse - let's go give some good care". The Dr-nurse relationship has become a partnership and the patient benefits.
Doesn't act like they already know what you are trying to tell them.
Is humbled, and can say they are sorry.
On this note, there is also a list of nursing do's and dont's.
I work with some amazing nurses. I work with some lazy nurses. There are good nurses with exceptionally poor communication skills. I also work with some nurses who want to retire, and really don't give a rats ass. I feel like I aspire to the first category.
A few things:
Shoot me if I ever say: "Just go in the bed and we will clean it up later"
A good nurse will call the family with an update, before they go on craigslist.
A good nurse will question Drs orders if they seem amiss
A good nurse is always wary in July
A good nurse will admit mistakes and apologize - to the patient.
A good nurse will tell residents and others if they did a good job.
I love a nurse who can cry
I love a nurse who can laugh at inappropriate times
crude humor is a must.
A good nurse and a good resident has a good heart, which more often cares than not.
So, the question is, what kind of nurse or resident do you want to be?
I MISS WORKING IN A TEACHING HOSPITAL!!!!!
ReplyDelete