Improving the relationship between intern and nurse

One of my readers astutely pointed out in the comments section of my blog that “nurses will make your life a living hell” if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses want to work with you not eat you.

Some of my suggestions probably appear ridiculously obvious, but I wouldn’t have been prompted to write these pieces if I hadn’t observed the examples below.

Here are some things to avoid:

1. “That is not my job” or “I’ll get the nurse to do it” are two phrases that can be heard by a nurse ears even if she were standing next to a jet plane at take off. The people who utter these statements send most nurses into a silent rage. If a patient is asking something simple and easy (like for a warm blanket and you are leaning on say, the blanket warmer) do not say “I’ll get the nurse to do it” and walk away. At that point, you might as well have relived yourself on those brownies you brought in.

Nurses know that interns, attendings, and students are run off their feet — but so are they! Don’t think that there are jobs more or less important than yours, and that you and your skills are at the peak of the ‘importance triangle’. It’s not beneath you to do non-doctorly things. Just imagine for a second how the hospital would run within hours of not having a laundry service, housekeepers, lab techs, office administrators, filing clerks … you get the picture. Until you’ve worked a few nights in small hospitals, you may not appreciate all the behind-the-scenes supportive work that many people do to keep the hospital afloat.

So if you have 2 seconds pitch in and help out. I’m not saying anyone expects you to change bedding, start all the IV’s, walk Ms Jones down to x-ray, but small gestures are noticed and appreciated. There is nothing more annoying than having an intern say to you “get Ms Jones some water” while you are whizzing by pushing an ECG machine and primed IV pole and they are sitting down to check their Facebook updates.

2. If a nurse is asking you a question about something, don’t blow her off with a patronizing answer or assume that they are questioning your care.  When I was nursing and I asked an MD a question, like “why did you use marcaine instead of lidocaine?” or “why did you chose heparin IV instead of sub cue lovenox?” it wasn’t because I was trying to be inflammatory it was because I was curious and genuinely wanted to know. Were there guideline changes, or new evidence based medicine protocols? Don’t forget that even though you’re writing the order, the RN’s are the one administering it, and many of them want to be right up on the why.

3. Messy handwriting is dangerous. Stop it. Many places are switching to computerized orders which definitely have advantages, one being that RN’s no longer will have to add ‘expert handwriting decipherer’ to their list of skills. As a new nurse I almost gave a patient with lung cancer Percocet (narcotic) instead of senna (stool softener) because of illegible handwriting and a missing-in-action MD. Thankfully, as the patient was about to tip them back I said, “do you normally take percocet at this time of the day?” to which his wife responded, “No, he’s allergic to Percocet!”

If you have bad handwriting, try and at least write medication orders clearly. It is also doubly sweet and handy if you alert the nurse who is taking care of the patient, “I wrote some new orders for Mr Jones and I added another antibiotic to his regimen.” It is bad for everyone when the nurse checking the charts during night shift sees that no one noticed an entirely new set of orders after the blood cultures came back.

“Albinoblackbear” is a nurse turned medical student who blogs at Asystole is the Most Stable Rhythm.

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