Thursday, September 30, 2004

Rules for Residents

It's that time of year again. We got a new crop of residents this summer and they're just now beginning to feel confident on our floor. This means that some of them have turned into flaming assholes. Some of them are not so bad, true, but this isn't directed toward the not-so-bad ones.

Please note that the nurse or lab technician will be referred to herein as "she". Nursing and lab teching are primarily female jobs.

The resident will be referred to as "he". While our resident population is split roughly 50/50, I have yet to meet a female resident who yells, uses profanity, or attempts to humiliate nurses in front of other people. Those who try such antisocial tricks have been, invariably, male. Suck it up, boys; it's life.

Rule Number One: Policies, procedures, and standards do not exist solely for the purpose of inconveniencing you.

There must, therefore, be some other reason for them to exist. Perhaps it's patient safety. Or worker safety. Or Federal law. If those considerations pale before the issue of your precious convenience, do not blame the nurse or lab tech who explains the problem to you. Do not complain to them that the policy is unreasonable. Do not threaten them. It will do you no good and only make you enemies.

Instead, express--civilly, please--your frustration with the situation, if you must. Ask for help. Ask for advice. We will then bend over backwards to help you out.

Rule Number Two: If You Are An Asshole, You Will Get Zero Slack From The Floor Staff.

Remember the resident who tried to tell me that an oxygen supply line was misconnected and berated me for same in front of a patient? He now gets called by every nurse on every floor to double-check every damned connection on every piece of equipment to which his patients are hooked. Every time.

He also was hard enough on a charge nurse I work with to bring her nearly to tears. This woman is tough, no-nonsense, and strong. I don't know what he said, but it must've been something. I'm sure he felt good when he hung up on her. I'm sure he felt less good when his attending physician called him on his behavior in the weekly ENT meeting.

Another case: A resident yelled at two nurses in the space of a week for not calling him with lab results. These particular lab results were within normal limits and there was no order to notify him with the results, so we let them go. That's our policy.

That resident got called at odd hours every night for six months by every nurse he worked with. We double-checked everything with him. We called for approval before implementing pre-printed protocols. We called for orders for suppositories and Tylenol. The pharmacists called before implementing pharmacy protocols. The lab staff called with every single lab result on every single patient. Around the clock. For six months.

His behavior has improved.

Rule Number Three: Being A Jerk Will Not Provide Your Patients With Better Care.

If you're personally unpleasant, we will delegate every interaction with you to whomever will accept the assignment. We'll take very good care of your patients--that's our job--but you'll get one, maybe two phone calls a day with all the results and news of the day rolled into three minutes.

Rule Number Four: Being A Nice Guy Will Get You Perks.

We play favorites, openly and unashamedly. If Resident A gets a nickname and plates of food set aside for him from the staff's potluck lunches, there is probably a reason. If Resident B is treated brusquely and with thinly-veiled hostility by the entire staff, you bet there's a reason.

Resident A is also much more likely to find people to help with bedside procedures than Resident B. Resident A will have a staff of willing nurses who will walk through fire for him if something is going badly wrong. Resident B will be told to find documents himself or call the lab on his own.

Rule Number Five: There Is A Very Strong Probability That The Nurses You Work With Know More Than You Do.

"Very strong probability" in this context means "virtual certainty."

Our hospital's average nurse has been working with a specialized patient population for more than five years. She spends hours with her patients several days a week. They tell her things they wouldn't tell their own priests or mothers. She sees them when they're sleeping and knows when they're awake.

She also understands the basic surgical techniques that doctors use and their effects on the body as a whole. She has a grasp of the lab values that she encounters on a daily basis and knows when trouble is brewing.

Most importantly, your average nurse has a good gut sense of when it's about to hit the fan.

Therefore, if a nurse calls you at eleven on a Sunday morning with the news that everything with Patient X is so far going well, but that she has a niggling suspicion that something terrible is lurking just beyond the bend, you should listen.

If a nurse tells you that your new patient is a drug-seeking wacko with aggressive tendencies, don't be condescending. Remember that this nurse is, in all probability, older than you are and has not spent the last fifteen years in school. More than likely, she worked with drug-seeking wackos as a full-time job at some point. Listen to her. Take her seriously. Keep your eyes open. That way, when the patient hoards Phenergan in his bed or throws a chair through her window because she can't get morphine, you won't be surprised.

It's not rocket science, guys.

I promise that your balls will be just as big at the end of the day as they were at the beginning, even if you're pleasant and civil to everyone you see. I promise that your integrity as a surgeon will not be compromised by apologizing to someone that you've screamed at. I promise that things will be much, much easier if you treat those lesser beings who keep your patients alive and healthy with respect and honesty.

If you don't, that's your business. Please be aware, however, that most of us have been through much worse than you. We have no compunction about mopping the floor with your sorry ass if you step over the line.

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