If you could give med students/residents any tips, what would they be? I see great issue with student physicians not respecting RN’s (and also LPN/LVN’s, APRN’s) and, as the child of two nurses, I want to help break down the barrier so more student physicians and nurses can benefit from a shared network of information and respect!
– anonymous via Tumblr
What a fabulous question. I worked at a teaching hospital with a major medical school and have had a lot of experience working with med students and residents.
My two favorite med student moments
1. The team went in to see my patient that I had just put on the bedpan (I didn’t know they walked in because I had gone to take care of another patient). One resident walked all around the unit for 5 minutes to find me, take me away from what I was doing, walk back to the room, just to get the patient off of the bed pan. When I walked in, another resident had already thrown some gloves on, turned the patient, got the bedpan, dumped the urine, and and cleaned them up. And he did it with a smile on his face. And he said thank you to me! We had a good relationship after that because I knew he would do whatever needed to be done, even if he was a doctor and I was a nurse. And I also told every single nurse I worked with and they all loved him too.
2. The attending wanted a manual blood pressure on the patient and I was in the room, but sterile because I was doing a procedure. So the med student had to take the manual blood pressure.. and had no idea how to put the cuff on and take a manual pressure. I had to stop what I was doing to take a blood pressure because the med student didn’t know how.
My tips for med students/residents
1. Always, always find the nurse and touch base when you round even if you’re not changing anything. Our report sheets typically have a list of things we need to talk to the MD about. I’ve also had multiple times where the resident will go tell the patient something and leave and not talk to the nurse. And they don’t put in orders or write a note for hours so I have no idea about the plan of care. A few times there were really important things I needed to know (for example, NPO status prior to a procedure in a few hours) that if I didn’t ask my patient, I wouldn’t have known. It looks unprofessional if the nurse has to ask the patient what the resident said. The residents that I loved always made it a point to talk to me, even if they weren’t changing things. They always wanted to hear my update, if I had any questions or concerns, and explain what our next steps were.
2. One really time consuming thing is figuring out which resident to call. Please make that clear on the chart which team is following the patient and update it if it changes. I remember spending hours getting resident after resident who said someone else was covering that patient. It would take hours to get a simple diet order. That gets nurses in the habit of saying, “screw it” and just calling the attending after two tries.
3. Answer your pager. I know it’s annoying getting into the habit of a pager, but residents were always the most difficult to get a hold of. It can ultimately delay patient care.
4. Please don’t enter an order unless you’re sure that’s what you want. When you enter it, I have to do it. So if you enter something, then decide that it should be something else, modify it, the modify it again, and again.. that’s all stuff I have to do. I had one resident put in an order for fluids, and every 15 minutes for over an hour, he modified the rate and type of fluid. I wasted so much time.. and by the time he was done, the order was the exact same one we started with!
5. Please call doctors personally if you don’t agree with their orders. The nursing staff should not get in the middle of all of that.
6. Stand up to the nurses that are jerks to you. Some nurses are jaded and are not nice to residents.. know that most of the other nurses are embarrassed by that and don’t condone their behavior.
7. We have no idea when you’re going to round and neither does the patient. Please don’t act like we’re inconveniencing you immensely when the patient is on the bedpan/in the restroom when you happen to round.
8. If an experienced nurse tells you something, listen. Some of the experienced nurses I know are so, so smart and have saved patient’s lives because of the things they picked up on before the physician. I know we’re nurses, not physicians, but we still deserve to have a voice in the conversation. An experienced nurse can pick up on really subtle things and put the pieces together quickly. We are with the patient for 12 hours and get to know them very, very well. We can tell when something is wrong, even if all of the numbers are normal.
I really think that med students/residents should follow an acute care nurse for a few 12 hour shifts. That way they know how long it takes to actually implement their orders and what patients have to go through. Then they can see how we interact with patients, how we balance care, how we work with multiple doctors from various service lines, and what we actually have to call them for. I think it’s important for them to physically see what a patient experiences when they order certain things. I’ve had a resident order q12hr labs in addition to PTT’s every 6 hours for a heparin drip and daily labs. The poor guy got stuck every 3 hours and the resident didn’t understand why I wanted to change it to consolidate sticks. I also had a guy with a terminal diagnosis.. like 4 months to live, get admitted and put on a cardiac/restricted diet. The guy is going to die soon and all he wanted was some whole milk and I had to convince the resident to change the diet for him. I believe that experience of shadowing an inpatient nurse will streamline care, increase efficiency and communication, as well as improve RN-MD relationships.
I think a huge gap is understanding what one can do with a nursing license versus a license to practice medicine. I frequently get residents that don’t understand what I can and cannot do with my nursing license. I can’t order any medications, no matter how basic, without a doctor’s name. I mean, technically I can’t even hold a Colace even if a patient has had constant diarrhea for days unless the order specifically says “hold for diarrhea”… otherwise, I’m practicing medicine by deciding which medications to give and which to hold. We also have a lot of protocols/order sets that tell us to notify the MD if certain events occur and it never fails that they are shocked I’m notifying them. If you are going to order a protocol/order set.. please be very familiar with it.
I could go on for days on the “Nurse/Doctor Disconnect” .. bridging the gap between medicine and nursing is something I am passionate about! If you have any insight from either perspective, please comment below!