July is the time when new residents start in hospital across the country. There is a general belief that this is the worst time to be in a teaching hospital. While there is not too much evidence on that fact, there are some things nurses need to watch out for. Nurses are every Physician's double check. Many mistakes are caught by nurses before they ever reach patients. When in doubt, speak up! Here are Adventure Murse's top 5 tips for surviving July.
1. Introduce your self: Behind the over confident face and brand new white coat is a nervous person. This is their first time as a "real" doctor. They will need the support of the nursing staff if they are going to succeed. Introducing your self helps break the ice. Take 5 seconds before you start your shift. It will also help when they order a insulin drip at 50 units per hour instead of 5 units per hour.
2. Work on your profesional communication: Most people do not appreciate it when people they just meet tell them that they are wrong. Especially after they just spent 8 years in school learning how to be a doctor. New doctors often are tough to talk with. You need to be extra careful on how you phrase your questions and conversations. For example, approaching the new resident who ordered Morphine 0.5 mg q8h for your cancer patient. Its probably best not to lead with something like "that dose is like pi***ing into the ocean". You should instead suggest that they should re-look at the dose. Saying something like, "Did you mean to order 5mg or Morphine?". You will create many less problems addressing issues this way, instead of insulting their intelligence. Interns seems aragent, but often are very nervous and are eager to learn. Be the nurse that is a helper and not the salty old nurse that lets them flounder.
3. Double check: Just as in the scenario above, interns often mix up orders or are just unfamiliar with how the hospital runs. This can be hard to catch, especially for a new nurse also just out of school. Use your resources, your charge nurse, the attending or a trusted senior nurse. The only stupid question is the question not asked. It does not hurt to double check, the patient is depending on you, the nurse, to get it right. There are no egos when it comes to quality patient care. If someone is angry with you double checking with them, go to someone else. If that person being angry with out is an attending giving the orders, go to your nursing leadership. The patient's safety is the most important thing. While smart and often right, doctors and nurses are not 100% perfect.
4. Watch out for the PGY2 doctors: Ok, this is a guide for dealing with interns. However the second year doctors can be just as, if not more dangerous. I had not thought about this even. When writing this article I consulted with a few of my attending friends. They reminded me that while new, the interns are being watched closely by everyone to make sure they don't mess up. They also are not the most confident. The second year doctor however has their ego boosted by no longer being the lowest on the doctor totem pole. They also are watched less by the attending as they are more seasoned doctors. Its important to know that just because they have black bags under their eyes and they mainline coffee like no other. They are just as capable as making mistakes as anyone else.
5.Forgive and Move On: Notice that I did not say forget. However it is important to forgive them. People make mistakes. It does not make them a bad person or even a bad doctor. However if they continue to make the same mistake or do not learn from their mistakes, watch out. We were all the new provider at some point. School just prepares us to learn as providers. We all started somewhere and needed time to become competent providers.
July is often a difficult time to be in a hospital. Many new staff are starting and it can be confusing. Just keep on learning and you will survive! Enjoy the nice weather outside and try to enjoy the ride!