Nursing Voices

Wednesday, October 11, 2006

The Intern Survival Guide

I worked as a neurosurgical nurse many years ago at a teaching hospital in the Midwest, and twice a year a new crop of interns descended upon our unit. It was the best show in town. The spectacle began with the chief of neurosurgery, Dr. Holier Than Thou, strutting on to the unit with his entourage marching behind him. He stood before the crowd in his impeccable white lab coat, telling everyone within earshot of his importance, and how he held the power of life and death in his hands. I would sit at the nurses station and snicker at the biannual parade, and remembered my first day in the hospital as a nursing student. Two interns had asked me to go into a patient’s room to get a set vitals signs. They didn’t tell me that the patient was cold, stone dead. I walked into the patient’s room, saw the dearly departed, and calmly walked back to the nurses station to find the interns laughing their fannies off. I told them they were going to make damn good doctors one day, but first they had to learn what rigor mortis looked like. Nonetheless, because every new group of interns looked like lambs being lead to slaughter, I pitied them, and I gave them information to use as a survival guide. These are the rules I taught them about working with nurses.

1) Nurses deserve respect. We are with the patients twenty-four hours a day, seven days a week, while doctors are only able to see patients a few minutes a day. Smart interns forge alliances with the nursing staff, and understand that nurses can save their butts when something goes wrong with one of their patients.

2) Don’t take the last piece of pizza in the nurses lounge unless you are invited to do so. Nurses are territorial about food.

3) Nurses do not tolerate interns with a budding God complex. Nurses have no problem calling arrogant interns every hour on the hour for Tylenol orders, especially at night. Arrogance breeds contempt.

4) Don’t be stupid. If you want to complain about nursing care, be careful when you approach a nurse who is working the last half of a double shift. Refer to rule #3.

5) Nurses are your friends. We want to see you succeed, and if we like you, we will make sure that Dr. Holier Than Thou doesn’t find out that you order Demerol 1000 mg, instead of 100 mg, IM q 4 hours PRN because you were dead on your feet after being on call for three days in a row.


Blogger The Curmudgeon said...

These rules are applicable to other businesses as well. All very practical.

1:31 PM  
Blogger Julie, RN said...

I heart you.

3:17 PM  
Blogger Joyjoy said...

I am goin to pass out copies of these rules to our interns!

1:35 PM  
Blogger Lola2020 said...

You have certainly got that sorted....our new doc's get nurses teaching them on their induction puts them in their place.

4:57 PM  
Blogger indynurse67 said...

So true....A nurse can be a doctor's best friend or his worts nightmare....I can do a lot of ass covering for the doc's that treat nurses and patients with respect. For those who don't...not so much!

9:56 PM  
Blogger Medagogue said...

Nurses are the backbone of the hospital.

11:25 PM  
Blogger doc said...

your intern survival guide doesn't apply to me.

i love nurses.

i've been happily married to one for 17 years& & have 2 lovely children to attest to that.

long live NURSES!

11:56 PM  
Anonymous Anonymous said...

i'm a chilean nursing student, i understand the feeling of being humiliated by some doctors, and find that the rules are very practical for our profession, sadly we have to find protection ways, for that kind of situation... i must say too, that not every doctor is like that.. there's some good elements somewhere.. i hope there`s some much more!!!

1:52 AM  
Blogger hondo said...

My wife has been an ICU nurse for 18 years. She has made the transformation from "one of the cool kids" on the unit to "old dog" and she tells me she can't really remember when the change happened. She, and her collegues, are the most remarkable women I have ever met. God bless all of the nurses in the world---you are doing the Lord's work!

3:14 AM  
Blogger Norma said...

A great post. My sister was a nurse. Oh, the stories she could tell.

5:43 AM  
Blogger Jeankfl said...

Wow! I just found your site. I've been a nurse for 30 years..I've taught more than a few interns and residents those very rules!! And made a few 2am Thanks for the memories!

12:46 AM  
Blogger The Angry Medic said...

finally, someone to teach all those arrogant interns some manners! you should print a pamphlet and call it Nurse Ratched's Guide To Interns. I'll help distribute it. I'm a nursisist (geddit? feminist = nursisist?)

1:16 PM  
Blogger Stel said...

I'm on a Neurosurg floor and thank goodness we have a good group. Have you read "House of God"? You could surely add your rules to the Commandments written in the book!

3:29 PM  
Blogger Cheryl said...

Oh, Brava! Well said!

11:20 PM  
Blogger Bhagwad Jal Park said...

Very sensible. It just goes to show new bosses that you have to respect the fellow who really knows everything.

11:35 PM  
Blogger NeoNurseChic said...

Love it!! I have many I would like to add, but maybe I'll make a post of my own someday! One thing I must say is that we had this ER resident doing a rotation with us for a bit last year. He used to make comments during rounds to the nature of, "If the nurses would just weigh him right..." or "He was fine until the nurses touched him." And you would assume these were said in jest, due to their sheer nature, no? They weren't... He was stone cold serious. So I hated him pretty quickly...

Then, he was taking care of one of my babies, during a time when I had one baby on an oscillator, one on a conventional vent, and only one not vented - who actually ended up being vented. Suffice it to say, I didn't exactly have a lot of time on my hands. He had problems calculating out total fluids and IV rates. While this isn't really a nursing job, I was taught how to do this so that I could double check orders and also come from a point of knowledge when I wanted to question rates. So I helped him. Time and time again. I don't really know why, as he had not been overly kind to me or any nurse, but he did appreciate the help.

However, the next time in rounds he pulled one of those comments about nurses, I said with a hissing sound in my voice, "Adam! That is inappropriate! Stop it!" Everybody his face turned red. I never ever told a physician soul about calculating out all of his numbers, but I was damn well not letting him get away with ripping us to pieces in rounds!

Take care!
Carrie :)

12:31 PM  
Blogger Intelinurse2B said...

I saw these principles in action during my OB rotation. We truly are dependent on each other-we need them, they need us.

8:30 PM  
Blogger Kal said...

As an EMT I work much more closely with nurses than I do doctors. Thrilled to have found you, instantly adding you to my Bloglines.

The reverse of your "last slice of pizza" is also true. I once drew the short straw on returning a car seat to our SCBU as the previous shift had forgotten to take it back. It was significantly later than they'd promised to have it back by, so I stopped off at the news stall in the hospital and bought a pack of Jelly Babies, tucked them into the straps on the seat and dropped it all off together.

Sometimes with nurses, food buys forgiveness. :)

10:32 AM  
Blogger Dex said...

I am an intern on a surgical floor (not my service), and I have found some things to be helpful in smoothing the way.

0. Nurses see the floor they're working as theirs. Interns are guests--behave like you're in someone else's house.
1. answer pages promptly
2. Ask the nurse what his/her name is, and try to remember it. Mega bonus points here.
3. Do not appear dismissive of nurse's inquiries--take what they say seriously.
4. The nurse will write your name all over the chart--write a note about serious issues and how you managed them. (more for CYA)
5. You don't have to solve all problems yourself--ask the nurse what they think/want to do.
6. Nurses are great resources for procedural info--how things are done type stuff.
7. Don't use the clerk's chair/computer/phone. They don't like that, and they gotta lot of work to do too. And some are quite techy.
8. Give drug company schwag to nurses. Bonus points.
9. If you order something, find the nurse and ask them to do it. Converse--try not to ask the nurse to do something without written orders. Drives 'em crazy.
10. If the patient has a problem with the care, fix it. Unhappy patients=unhappy nurses=unhappy doctors.
11. Support nursing in public settings. What's good for nurses is generally good for doctors and patients.

7:03 AM  
Anonymous Anonymous said...

Dex's post reminds me of how far the pendulum has swung. I can't remember the last time I actually saw an arrogant intern. Those I've seen are afraid they might somehow offend the all powerful nurses, to the point where they will take any mistreatment.

I am here to do my job, which may or may not involve being stuck in this hellhole for 30 hours straight. I will be happy to be friendly with you if you are friendly with me. If you want to fuck with me, yes, you can page me for dumb shit. But I write the orders that you have to carry out. And if it becomes a game of tit for tat, that means I've got the edge.

Now that's never actually happened, but I'm not going to go around feeling like I'm obliged to bribe nurses with food and goods just so they'll do their jobs without harassing me. Be a polite coworker, treat them with respect like you would anyone else, and don't be a pushover - that should be the Intern Mantra.

7:05 PM  

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