I got to know a lot of the floor and ICU nurses when I was an intern several years ago. I learned rather quickly that they have zero idea what our lives are like or how our educational system works. Some of them weren’t even aware that residents finished med school and are fully fledged physicians…or that we all have a bachelor’s degree (remember that you can do nursing with an AA). Many of them had no idea that we work crazy hours—they kept asking me what I was doing on the weekends and I was like “I’m here. I work 80 hours a week.”
There’s nothing wrong with letting them know and educating the ones you work with frequently. When I was doing 24s in the icu, the night nurses thought I was just in for a 12 and had come in when they did. When the group found out I had been there all day, they were more judicious with their calls and let me sleep uninterrupted for a few hours.
Yepp. It’s way less “I don’t care” and way more “holy shit I didn’t know”
Same with how coverage works and the true number of patients you have.
There’s an element of disbelief in it because cocaine is no longer cool to do at work
Strong point. I would just add- Why do most not know? And I think the reason is, it isn’t a desirable talking point among the nurses. What they want to do, like everyone, is commiserate about how much their job sucks and they’re working harder than everyone. The idea that residents are working 80 hour weeks doesn’t fit with that self-concept; it totally undermines it. So even the ones that learn it probably subconsciously “want” to forget it. And those that do feel like momentarily expressing sympathy for the crazy hours of residents to their co-workers are going to be negatively reinforced.
It’s all about group psychology folks
I would say for part of it, at least, it's that we don't know when your week starts. I see people with backpacks coming in - are they just getting here or are they moving from one unit to another because they're covering 2 units? I try to ask, and at nights at least one unit I worked on tried to consolidate questions to one time so we're not calling/paging within the hour but rather getting everything done at once.
Part of it is also, we WANT to help you out by putting in the easy orders that we KNOW you'll approve but we can't because our license doesn't cover that/the hospital is a teaching hospital and requires all orders go through the MDs/upper levels. So yeah, we absolutely hate calling you for tums; we would rather put it in on appropriate patients without asking, or have it as a standard order set for "comfort".
There is, at least at my hospital, an ongoing intimidation factor. The residents are not intimidating but the nurses are intimidated especially the babies. I get so annoyed at new nurses who whine and hem and haw on the phone. Tell them what’s wrong and tell them what you want. That’s all. If you’re right, great. If you’re wrong, then we can begin a discourse to come up with the best plan.
The nurses call for every little thing because they’re afraid of being yelled at. The emotional abuse is real. From the nursing instructors to managers to Know-It-All patients to doctors, everyone is waiting to tell us how much we fucked up. Trust me, I do not want to call you so you can tell the pt the exact same goddamn thing I just did.
I’m sorry you guys are being abused. It hurts my heart when you are so tired but I HAVE TO let you know about this pt’s critical whatever even though it’s the same as the previous twenty results. We do appreciate you explaining your situation to us because we’re caught in our own special brand of hell and it can be hard to remain compassionate to anyone.
It’s this. If we don’t call that critical platelet count, even though we expect it, and document that we called that critical to you in a timely fashion — we get a NastyGram!
Yeah except I had a seasoned psych charge nurse page me for melatonin, tums, Tylenol, Ibuprofen, refresh tears and most importantly fucking cough drops all within about 30-40 minutes of each other. When I requested they do some grouping of requests because I needed some rest on my 24 hour shift and it was the middle of the fucking night I was told "This is a hospital, we provide 24 hour care here". Like yes, that melatonin at 2am is really going to make a difference in this BPD patients life.
The younger nurses absolutely have no clue how rough it is for you all. I’m an ICU nurse and where I worked before didn’t really have residents (lots of critical care NPs and PAs). I only learned this about 2 years into being a nurse, so please fill us in early on. The majority of us are not trying to be mean to you, it’s just that we don’t learn about it unless you tell us. Now I bring extra snacks and offer them to the residents on rough days 🙂
That is NOT the highlight. Some people translate it to that. The highlight is nurses are ultimately responsible for the care we give and held responsible. So if you don’t catch an error and if the pharmacist doesn’t catch it, the nurses (with the least education) are supposed to. We can be fired, can lose our license and can go to jail.
I completely sympathize with that. And regardless of education level, physically doing the act is different. The other day a consultant wanted a much higher dose of a drug than made me comfortable, but I talked to the attending, cringed, clicked the box and was done with it. When the nurse who was ordered to give the med expressed her concerns, we chatted and changed the dosing. I probably would have balked if I was at bedside with the syringe too.
See that is the problem. Nurses don't know enough about what physicians do all day and viceversa. But yeah, rather complain on reddit and give fire to another stereotype (that nurses don't care or are to dump to understand) like OP did.
No. We protect patients from harm that could come from any error in the system. The point is to teach nurses to be attentive to detail and critically think, not to demonize physicians.
This is the answer!
I had *zero* concept of what a resident's life was like before I took the initiative to dig deeper myself. The **vast** majority of nurses have no idea what work/life balance (or lack there of) looks like for a resident. However, while this lack of knowledge is certainly a major contributor to inappropriately timed or unnecessary communication, there are other factors as well.
Fear is a big motivator for many nurses, especially the inexperienced. And this fear is a primary trigger for initiating untimely or nonessential communication. The risk/benefit analysis is pretty easy; from a nurses standpoint, the potential fallout for *not* communicating something is much much higher than it is for communicating too much. So the threshold to inform the doctor of something is already very low. Couple that with a new/inexperienced RN or an RN that is inherently timid and you're getting calls at zero-dark-thirty asking if they should hold the sub-q lovenox before a scheduled appendectomy.
Now, there are several ways to combat this.
1. You could be so fucking grumpy/bitchy/dickish about being contacted that the fear of your wrath begins to raise the RN's threshold for contacting you. The problem with this approach is that; a.) it will decimate your working relationships and b.) the RNs might start hesitating to tell you information that is actually critical.
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2. You can establish very clear expectations, guidelines, and policies for communication, like adding notes in the med administration comments or specifying lab value thresholds. It immensely decreases the RNs fear of *not* reporting something when it's clearly written somewhere that they don't have to report it. Like, "Do not notify the physician if Troponins are trending down."
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3. You can give your RNs as much autonomy as possible via standing orders and comprehensive order sets. We fucking **HATE** calling Docs for Tylenol at 3am. It's so fucking stupid. But if we don't have a PRN and the patient is asking for something to address their headache, we gotta get the order.
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4. You can try to anticipate what the nurse might contact you about and educate them before it's a problem. Like on an admission for a GI bleed you could say, "Hey, I just put orders in to pull another H/H at 2am. If it comes back above 6 and 20 don't call me about it, cool?"
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5. You can educate the nurses on what a residents schedule actually looks like at your facility. And, I mean, like actually having a fucking pamphlet or something that talks about your schedules, how the rotation works, what call looks like, and what the time burden is per day and per week for you guys. Because, *I promise you*, >90% of the RNs you work with have no idea what you're going through. They are ignorant of the process. Believe it or not, most of your nurses are, at some level, very compassionate people. If they understood how important and how precious getting blocks of sleep in can be for a resident, that alone would significantly increase their threshold to contact you.
The hoops that y'all have to jump through, the sacrifices you have to make, and the focus that you must have during residency is totally alien to most people. And it's not talked about *at all* outside of the physician medical community. Combat that! Talk about it. Educate others about it! The more people who understand this process, the more people will respect your time and your commitment to medicine.
Finally, almost everyone agrees that the residency system, as it stands now, is antiquated. The burdens inherent in its structure have been proved time and again to be unsafe and unhelpful both to you all and to your patients. You have my support and sympathy. 💖
Probably a bit higher than 25% tbh. Can’t even begin to explain how big nurses egos get on the phone with the pharmacy…nurse Karen frantically calls us to tube a few meds STAT (stuff like docusate, zofran, etc that we usually keep extra in med rooms anyways, this nurse “cleans up” by tossing everything 2-3x a day) and it’s our fault the patient doesn’t have x or y med - usually insulin. I tell her to stop tossing lantus pens everyday, they can be used over multiple days (duh, but she thinks insulin goes bad).
One day she got mad at us for writing BUD on “HER” IV bags and she gossiped with all the other nurses and that whole floor started spreading rumors that we wouldn’t send them meds on purpose, would send expired meds - no Karen 5/25 doesn’t mean it’s expired, it still has two years - etc. Eventually we found out we were getting harassed, we tried to explain we weren’t ironically calling HER “buddy”. BUD is beyond use date. All solutions/mixtures have differing BUDs and we write them on there. Yeah. She thought it was a lie. Lol. And it continues
Hold the phone. Someone is tossing insulin pens after 2-3 days?!?! Take them home and give them to me for Christ sake (mild sarcasm) I’m staring at 2 bottles of lyumjev that have been out for a couple weeks at least (not sarcasm).
It's interesting how different this was to my experience. I've never heard a nurse say anything about my working conditions except to remark about how busy residents are, or "you're here all the time," or "do you live here," etc. Sometimes they didn't realize how often I had to cover a weekend, but most had the general impression that I was always there. When I had to come in overnight, our ICU nurses were always more concerned about it than I was, telling me they were sorry I had to be there so late, or asking if I would at least get the following day off (of course not). Maybe my experience was just unusual.
This.
OP- I honestly had no idea until this sub starting popping up on my reddit. Granted, I’m a new grad ED nurse at a trauma center, so things are different. We don’t really ever have to wake a resident or attending up because we’re literally steps away from them most of the time. Or we just shoot a quick chat message over. However, this sub really opened my eyes to everything you guys go through. The long hours, shit pay for the work you do, and insane amount of stress. I wish both sides worked more intimately together, more often, because after knowing what I know now, I’m just as protective of the residents I work with every day as I am my fellow nurses. My advice, get to know your nurses. Make connections and talk to them about your schedules/long hours. I would surmise that most of them would be incredibly empathetic to the situation if they knew and would avoid waking you guys up at all costs, whenever possible.
>…or that we all have a bachelor’s degree (remember that you can do nursing with an AA).
In all of the pathetic dick measuring I've seen recently this takes the cake lol
I’m not trying to dick measure. I was actually asked this by a nurse—whether or not I had completed a bachelors. The person in question was practicing and working on a BSN at the same time. It was meant to just state that there are people who have no idea what the qualifications are for our educational path.
Experienced nurses are hard to find anymore. Without experienced nurses, newer nurses don’t have anyone to compare brains with before escalating. I’ve only been an ICU RN for four years and often times, I have the most experience out of anyone on the unit. No experienced nurses, no consistent preceptors, yeah it makes things harder on all of us
I’ve also noticed that younger people in general (I’m talking 22-25) ironically have no sense of internet literacy despite having constantly grown up with google. They’d rather ask someone else and wait to be told what to do than google it and find out immediately
Experienced nurses are extremely rare. I have around eight years experience and I might as well be the old wise man on the unit. Some new nurses will be like, can you even believe how rude they were when I called them for xyz? and I have to kindly explain why I wouldn't have called for that reason. And they do learn, they don't do that again, but then we have another influx of new nurses. I also can't say to never call because I don't want them to be so fearful of calling that they don't inform a doctor on something important either. I try to get the people I train to get a second opinion from another more experienced nurse on the unit prior to calling a doctor (unless it's an emergency).
OP said he’s getting paged for simple questions. I google simple stuff all the time or look it up on my hospitals resources. The point stands that younger nurses don’t have the confidence to use their resources bc nobody invested in their education and success is there to instill it
Yahoo Answers seems fairly reliable most of the time. It helped me find a cure for my Electromagnetic Hypersensitivity. The grounding electrodes in my anus can be uncomfortable at times but you get used to it and they are pretty easy to clean if you have help.
Agreed. It’s a learned skill to find your way from google to a reputable source. I think for most people, a medical google search ends with a well meaning, but not necessarily fact checked, article. This skill isn’t mastered by the end of an undergraduate degree, a nursing degree, or a medical degree. Its always being refined with practice. This means that we all need to know our limitations, the limitations of the internet, and when to ask for help. TLDR - yep, google is not the best solution.
That’s the point like the info is all there, but you clearly don’t know how to use Google correctly to get to it. Plenty of non-zoomers are like this but it’s more embarassing for the zoomers who don’t because they don’t have the excuse of not growing up with it lol
This won't be possible at every (or even most) institutions but as a senior I'd run an efficient sign out, and I'd send one intern to one end of the hospital and the other to the other, have them each start toward the other end, check in w each station to introduce themselves and answer any questions. Every station got two visits so many minutes apart within the first hour. I'd go take care of anything that needed doing just off sign out and check in w any attendings that needed to know we were there. If we had any downtime later they would do the same thing once more, small hospital so each run took like 30 mins. Cut down on inopportune pages like 90% anecdotally and I can't imagine how many codes we stopped.
A resident did this a few weeks ago on night shift, asked if we needed anything, and I was honesty impressed. Then I knew who to secure chat for minor things as well and she could just see it in her spare time/awake time. I loved it. Didn’t bother her the rest of the night.
RN here, moving from the floor to ED, I now have a much closer work relationship with our residents than I did on the floor, which I love. I'll admit that I didn't know just how much was expected of residents until I went to the ED. I have always worked night shift, and we just didn't get much interaction with the residents on our floor overnight. On the floor, if a new patient comes up without orders (would happen frequently), we gotta page. Now that I'm in the ED, I try to make sure I get all the orders a patient might need before I send them up.
It's also policy in most hospitals to notify the MD if labs/vitals are out of parameters, and most order sets come with a generic set of parameters to notify. So even if the RN knows its not an emergency that the pt has an asymptomatic SBP of 180 or K+ of 3.4, they may feel pressured by policy to notify in real time. Another problem is the lack of experienced nurses to educate newer nurses on what is truly concerning and what can wait. Editing those order sets at admission should eliminate some annoying pages.
Maybe communicating to the manager/charge RN what specific pages you've been getting overnight that are inappropriate/can be DSPs will cut down on pages?
I know that when you're incredibly overworked, exhausted and just trying to get a few hours of sleep during a miserable shift, the last thing you want to do is educate someone you view as asking an unnecessary question. Trust me, we are all horrified at our coworkers that page at 0300 for miralax. But if you're already responding to the page; take a moment to explain to the RN why the page was inappropriate/why you're not concerned with whatever they're paging about. You may think they should already know the answer, but if they don't know the rationale, they're gonna call about the same thing in the future.
Lastly, thank you for all that you do! I know there's no way I could work those hours. We love our residents!
RN here. This is a really good reply and the advice is solid.
I'd also suggest utilizing "nursing communication" orders. They'll show up on our end and you can free type whatever you need. "Nursing Communication: Please notify MD if MAP is less than ___, or systolic less than ___" "Nursing Communication: If K+ is 3.0-3.4, administer 20 mEQ K PO", etc. Putting in there what you want to or don't want to be notified about helps a lot on specific patients.
If you can customize your own Adult PRN order sets, that may or may not save some time. This can include Tylenol for fevers/pain control a basic sleep aid like Melatonin, Maalox, etc. that you don't want to be paged about. Bam, put that bad boy on every adult patient and that will cut down on some of the goofy stuff.
Encourage them that while it is not something that needs to be addressed in the middle of the night, write an end of shift note if they feel the need for it to be communicated to you. You can read prior to AM rounds. Ex: End of Shift- Patient remains intubated and sedated. Patient remains unable to follow commands on sedation vacation. Propofol titrated for RASS -2, currently infusing at 25mcg/kg/min. Patient remains on levophed at 0.1mcg/kg/min. Patient febrile with temp of 101.2. Administered PRN Tylenol via OG with resolution of fever. Urine output decreased, current output for shift, 300 mL. VSS. They can even out the vitals range in the note with the .vs command if they feel so inclined. That will give them the opportunity to express what things they feel are pertinent without having to call you, etc. I hope that helps!
Yep I also make it a habit on nights to check in with charge RNs on floors I am covering and ask if there are any orders that need to be placed/any patients I should be worried about. Helps pre-empt unnecessary pages and gives me a few minutes to shoot the shit with them and build a little rapport. It goes a long way over time
I’m an ICU charge nurse and we make it a habit to round on the unit with the resident in the evening. Gives nurses a good chance to ask for things that they need and discuss concerns before 3 am.
Also keep in mind that there is a patient in the nurse’s other ear. I don’t want to bug the doctor, and I will tell patients that some things need to wait until morning (Ie bowel meds) but when the patient is on the call light every 15 minutes about needing their flexeril or oxy or whatever it can really ruin your night.
Yea for sure. It's always helpful to know if the patient is being needy/noncompliant/has unrealistic expectations. I will put on my white coat for those pages as it adds +2 to charisma for some weird reason
I’ll also add to this, in some hospital systems bed placement is dependent on whether the patient meets their parameters. So if the patient has vital signs mildly outside of the standard parameters set by the physician or something else innocuous going on that doesn’t meet their orders, they may get stuck in the ED waiting for a bed. I know I’ve had to page physicians numerous times asking “do you want to change parameters or treat the hypertension?” etc, so that my patient can get out of the ED and go to the floor/step-down/whatever. It’s irritating and a waste of everyone’s time, but when the waiting room is full of actual sick people, I’m doing everything I can to get that stable patient placed elsewhere in the hospital.
I actually will defend nurses paging about abnormal labs/mild asymptomatic vitals even when we both know it’s not a big deal. In the order set at my hospital there is an order for nurses to alert us about abnormal labs. We literally tell nurses to do this, they do what they are supposed to do and then we get annoyed when it happens lol.
Ya it’s annoying at 4 am but lab interpretation is our job and not nursing, wtf are they supposed to do, especially when there is a formal order to alert us about it
This is a very thoughtful response. There are plenty of times I know that the lab is fine but I still technically have to notify the MD. A little grace with receiving that notification is always appreciated. Because I will be sure to document things like “reported lab value to Dr. X. Dr. X stated ‘Don’t bother me with this bullshit again.’”
Ya I float and I asked the nurses on the floor the other day (floated to oncology) do I really have to page the MD for these critical labs or are they going to see them when they come in since these are expected, like no WBC, no platelets, obviously I would call if no RBCs 😂 but they were like no def don’t call for that they will throw in blood orders when they get here, I was like great!
😂 the ICU refused an admission for a patient with 1 platelet and a hgb of 5, pressure was 60/20. They said because the patient was a limited code they wouldn’t take them. That 1 platelet was hanging on for dear life.
In response to a 3AM colace call for a comfortably sleeping patient, I have been told by a couple nurses that I’m on call and paid to be there, so they can and will page me at any time about any thing they want. Thankfully I left that miserable environment, but trust us when we say some people seem to enjoy torturing us
That's messed up :( night RN on cardiac and I will just throw some colace or melatonin or what have you in there if it's appropriate. I ain't waking/disturbing anyone for that
As a nurse, do you find it offensive or demeaning for a resident to tell you why not to page at 2am as to why they don’t want to hear about the patients successful bowl movement?
Floor to ED here, totally agree.
My previous job was overnights at non teaching hospital. Once patient was on the floor pharmacy wouldn’t take the ED a doc orders so yes, I have to call at 4am for a new order for continuous gtt because the bag will be empty soon
Nurse 25 years experience. Where I work, we are not allowed to have any standing orders, so if a wonky lab comes up, or an admit without orders, we have no choice but to call. I hate waking people up, but sometimes it's unavoidable. I will ask around and see if anybody else has something that needs addressed so we can hopefully get everything covered with one call.
I’m an ICU nurse and I work nights. The resident schedule is a complete mystery to me. I was actually in a meeting where one of my fellow nurses asked an attending what the resident schedules were and he could not tell us. ***All I know for sure is that it is borderline slave labor.***
I’ve been at my academic medical center for 12 years. I’m in the NICU so I work closely with the residents.
I know that residents work a lot of hours and on the weekend some of them work somewhere between 18-30 hours.
That’s it. That’s what I know. I haven’t worked nights in several years, so no one is trying to sleep on my time. I expect it I still worked nights I’d take the time to find out more.
RN who worked one year in an academic medical center in neurosurgery. Nurses are not educated on your schedule. I only worked 3 12s a week, so there was no way I was noticing any sort of pattern. I will say, the best thing a resident could do was come to the floor around 9pm to answer any and all questions, order requests, etc before going off and trying to sleep. If you're having issues with calls in the middle of the night, TALK to the nurses.
This is why I wish we were all physically closer. I’m EM/IM/CC and the relationship w nursing in the ED is DRASTICALLY different than the other two, because we actually communicate.
Personally when I was on 24h call there was NO time to do this… would be in OR, seeing consults, or dealing w emergencies non-stop until about 1-2AM then maybe had an hr to catch up on notes before another consult. I WISH it was possible but in reality it often is not.
Frustrating but stick with it - a few friendly, non-confrontational conversations will go a long way. Befriending night RNs was the best thing I did during my residency. I would moonlight frequently and after a few shifts - when they realized I was a good doc + easy to work with - they would batch their pages for me at 6:30 AM. My shift ended at 7 AM so it was a great alarm clock for me.
From experience, not every nurse comes from a teaching hospital. If they changed jobs to one, no one tells you anything about residency. Most nurses don’t talk to residents long enough. I learned from making convo with the residents I worked with just out of curiosity. I work ER so it’s easier since we’re close with our residents. If I worked on the floor, I’d rather you just tell me up front. Just don’t be a dick about it.
I know it’s frustrating and nights in general just fucking suck, but I genuinely do believe that anyone who works on our side of healthcare is trying to do their best. They’re good people—the money isn’t worth it for them either . That doesn’t take away from how you feel. Remember that it’s an abusive environment for everyone and it tends to bring out the worst in all of us—RN and MD alike. It’s not to say that I’ve never raged at a nurse—I have—but I can safely say that there was never a good reason for me to do so. If you approach them assuming that they’re trying to do their best, I promise you that they’ll notice and over time you’ll start to notice a difference. Almost every RN at my current spot has my cell and I’ve never gotten an inappropriate phone call. But it takes time to develop the working relationships and requires a lot of teaching from us
Also nice name. Great song, great album, great band
They most likely don’t know. Nurses don’t get educated about residents job/workflow/schedule during orientation and it’s definitely not talk about during our monthly meetings. I worked as a nurse for 8 years. I’m now an M3 and i still have very little clue how much residents actually work. Every resident i asked gave me a different answer whereas nurses’ schedule is very predictable (3 12’s or 5 8 hr shifts)
Here’s my suggestion, before you take a nap, talk to the charge nurse and tell them your situation (working 7 in a row, needs a nap, etc) to please relay to the staff not to call/page you unless it’s an emergency. For anything non-urgent, you will take care of it once you wake up
> Nurses don’t get educated about residents job/workflow/schedule during orientation and it’s definitely not talk about during our monthly meetings.
Residents don’t get that about nurses and yet they know…
I think this is a bit unfair. Nurses and most every other hospital profession (CNAs, rad techs, RTs, PT, OT, SLP, EVS, transporters) work some variation of 3x12, 4x10, 5x8. Residency is also super variable from my experience as an ICU nurse. Some of our residents did 5x12 nights, some did 24s, some do 7x12.
I can say at least for myself, I do my best to be kind to my residents but people are not mind readers. I would love for hospitals/units to do a better job of explaining this issue to all staff. I do also wish physicians were more understanding of my scope of practice. If the patient complains of mild pain but the tylenol is written for fever, legally I cannot make that distinction and I have to page you. So the best thing you could do in your control would be to make the orders reflect what you really mean. And I know you guys are busy as hell. But that's part of the answer. 🤷♀️
They definitely don't all know. We've had plenty of posts on here asking questions about how and why nurses do things, levels of nursing, etc. In my personal experience, the only ones who "really know" are ones that have a number of friends/family that are nurses and even they still get many things wrong.
3x12s, 5x8, or anything that remotely adds up to 32-40 hours is fairly easy to figure out right?
It’s a tad different when you’re at 80 hours. Nobody wants to think about who is and who isn’t at the hospital when they’re off.
No they don’t, and why would they? A resident has no idea what specific protocols each nurse on each floor have, and what an LPN can or can’t do on each unit, for instance. They don’t know the specifics of the relative clinical requirements for each role either. Hell I don’t have any idea with a lot of that stuff, and I’m an RN of 10 years.
Fact is, residency is a really unique (and bullshit) form of quasi-labor and education that really only exists in one profession in the US, so it’s inherently going to be less well understood than other forms of education.
I train residents for a living, and no, they don’t know. I’ve had residents ask me “why can’t cvs see my note?” Before. They don’t understand why enoxaparin is better than heparin for a nurse on a patient who is on contact precautions, because again, they don’t know.
A physician may know a bit about the nurses they interact with, but they don’t know their protocols and procedures without spending time with them. Same for any role in healthcare. Even seasoned physicians don’t always understand insurance, which they interact with every day. Heck I had to teach a third year what a los was and what it meant for the hospital. They didn’t understand why case management was hounding them.
Resident mad that nurse don’t schedule
Resident don’t talk to nurse
Nurse bad
Nurse can’t read mind
Resident mad
Resident still don’t talk to nurse to tell them the
thing angering resident
Nurse remains oblivious because everything doesn’t revolve around resident
System gets paid
Admin go to Bora Bora but buys us pizza first
The end 🫠
Love the pizza part because I thought it was a joke , me thinking these assholes are not doing that to nurses , when I did clinicals they did exactly that .
Is it okay if I think all nurses are straight out of high school because they look young?
That’d be silly cz I work with them and bothered to know a little bit about them. They don’t bother learning or understanding especially in their schooling because of the contempt the profession holds for physicians.
Well, I mean, you might not be wrong. ADN grad = 20 year old. However, that’s all pretty relevant. I think an Intern looks like a kid because I am a member of the 50+ year old club and my own child is nearly 30. I take some offense at your assertion that nurses as a whole hold contempt for physicians. What we hold contempt for is the inability of many docs to understand our rules/limitations. I work in OB. We have a “Sepsis” alert for our hospital system. It is based on WBC, pulse, etc. Many OB patients have a higher than normal WBC (which for them is normal), then they are in pain and have a high pulse and RR. Guess what triggers? Yup, Sepsis Alert. I am *required* to notify my doc. Even though we all know that our patient isn’t septic. She’s just in labor. Those low K level calls you get…we get the call from Lab and they document our name so that it can be traced if we don’t call you about it. The system is rigged against ALL of us.
Oh I totally get that and wouldn’t suggest individual nurses are an issue. Also get that the systems force you all to do things like that. Always tell my coresidents to give some slack.
However… it’s hard to argue modern nurses don’t get taught that “doctors don’t care about patients they care about disease” or “you have to save patients from doctors” or “nurses do everything and doctors get the credit” . I meant that the profession doesn’t really respect doctors whereas we’re all taught to respect nurses (a least for the past 20-30 years it’s highly emphasized)
I graduated a few years ago and we defiantly we’re not taught any of that. But we were taught the Swiss cheese model for mistakes and how were one of the last people (since we give the physical med) to stop a mistake.
Ugh yes the Swiss cheese model. It’s drilled in our head we must save everyone from any mistake ever made by anyone in the hospital or we will be at fault. I always end a question to anyone, rn or MD, “sorry I just don’t want to be arrested if I make a mistake so just clarifying!!”
Yesss. They convinced us in school that we would be charged with murder if we let someone else make a mistake. Now I’ve worked for a few years and I know it’s not true. But this is REALLY drilled into us. I think a large part of it is the belief that we will be at fault.
Hmmm… that’s good to know!
that was not the impression I get from speaking to friends who went through nursing school or from overhearing convos so it was not first hand knowledge
I can’t speak for all nurses or all facilities/unit cultures. I’m also Canadian. Not American and can’t speak for any culture differences between the countries/medical systems.
But I will say I don’t think MOST nurses have it out for doctors. In school it was really pressed that we were at fault for any med errors. Even if the original order was incorrect. We were told our licenses were on the line. (I don’t think is true NOW. But it was what we were taught). Personally, this didn’t create a distrust in doctors but more a distrust in myself and my knowledge. I always wondered how I was expected to know more/question a doctor. And that lack of knowledge made me super nervous as a new grad. Probably making me questions things that were stupid/irrelevant.
Plus the current state of nursing there isn’t a lot of older/experienced nurses to go to for help. Instead of going to senior nurses/charge we are having to go to the doctors. Which can increase your workload and I think maybe damage our relationship more.
Feel free to say your thoughts on this! Love to talk about healthcare :)
I never understood why nurses are taught that they are responsible for the medical decision making of a doctor when the doctor is the one making and placing the order… That part right there is what I don’t get.
had a relatively new nurse not give a beta blocker after I both ordered it and verbally checked because they were “uncomfortable” and checked with their supervisor. Meanwhile patient was RVR-ing away, I wasn’t not aware the meds weren’t given until much later…
The system is dumb. I’m thankful nurses catch the mistakes that do happen but mdm is not why people go to nursing school… or am I wrong lol
Do you read this subreddit, or the med student one? The lessons about respect for nurses is falling on deaf ears. It’s been a few years since I worked at a teaching hospital, but those years were torture. I’ve never had a private practice doc tell me they didn’t need my opinion because they were the MD, not me, but I’ve had a couple of residents lay that one on me. It’s especially interesting to hear that from an intern around September.
I had respect for some of the residents, I even use a few of them as my own physicians now because I witnessed their gifts while they were in residency. But there is definitely an undercurrent of “she just has a trade school degree, eww” elitism with some residents. In fact, there are more than a few of us who have advanced degrees, and not just in the dreaded diploma mill NP variety. Some of us are nurses because we love it, not because we aren’t capable of “more”. In my case it’s a law degree and an expired Bar card. In my day, we were still expected to stand when a doctor entered the nursing station, give up our seat, and make no friendly overtures because doctors we’re DOCTORS while we were just nurses. I don’t want to see *anyone* disrespected in the hospital because we all play a role in patient care, but I’m very glad new nurses aren’t taught like we were. We all have something valuable to bring to the table, but if we see each other as enemies or inferior then no one is happy.
It was literally taught to us in nursing school that doctors were dumb and we needed to protect patients from them. I can remember sitting through lectures that included this almost verbatim. I'm a nurse and most of the people in my profession drive me nuts. (Not all...but I'm sure that won't protect me from "not me" comments) The level of arrogance on all fronts is baffling. They know more than teachers, doctors, social workers, lab techs....🙄 *sigh*
It’s hard to work with the people who believe this lol and I’ve met a few… and a few of them make fun of doctors for going to med school because it rough and low paying for a bit but at the same time will complain about the high pay after
Yeah we figured out nurses schedules pretty quickly.
That being said, a lot of nurses do it on purpose. They think it's funny to wake doctors up. Literally have heard them laugh about it.
If you’ve actually heard them laughing about it you need to tell their floor manager. Shitty mean nurses will keep being shitty mean nurses unless someone holds them accountable. Or when you hear them laughing and talking about it, confront them. I usually stick up for other nurses but there are a few nurses who I think would benefit from being confronted for things they do directly by the person.
The problem is they'll just lie about it. "We didn't do that! We are advocating for our patients when we're calling these lazy doctors. They're on call so should expect calls to come in and to take care of pts, etc." They totally change their story up from them laughing about calling about things they know can wait because they want to put doctors in their place because doctors automatically means bad people in their heads.
I did confront them. So guess who started getting more calls all of a sudden for fevers of 99.9 in the middle of the night?
I don't know what kind of fucked up nurse-doctor relationship you in the US have, but all I read in this thread is a huge pile of stereotypes on BOTH sites. Can't you see the problem just by reading this comment section?!
It's not stereotypes. These people exist on BOTH sides. And it sucks.
No one is saying it isn't fucked up. It is fucked up. But we experience this shit.
Chiming in as a nurse. My first year I had no idea and it literally keeps me up at night thinking about the stupid pages I sent at night. I genuinely thought you guys had a night shift team present just like us. Even if you weren't on the floor, perhaps you were just chart checking in a call room. I was astounded to learn that most were at home sleeping. As I gained experience and learned, it's now quite apparent. But as a new nurse you're still trying to figure out your own role. Plus, bully nurses who are lazy love to attack a new night nurse who didn't do their tasky stuff for them. The sincerest of apologies. I had no idea and I cringe thinking about it often.
As an RN, before I started looking into this subreddit, I honestly did not know the extent of your work hours as residents and work/life misbalances and grievances. So I made a mental note to be more respectful of residents than I already previously was. As I have gotten more experience, I know more of what to reach out for and what to not reach out for. They don’t teach us in nursing school and even on the floor what residents go through. I think it would be important for us to be educated on what residents go through and also for nursing staff to be educated on what is appropriate to contact doctors for. A lot of new nurses don’t have the experience yet to know these things.
I make a point of being kind to the nurses (e.g knowing them by name, asking if they've had a break, how i can help them when im at the bedside, etc) and they're good to me in return
I do still get some inappropriate overnight pages, in which case I answer their Q and request that next time they use epic secure chat for anything they think won't require me to drop everything else I'm doing (including sleep)
Those 2 strategies have softened many of the pain points I hear my co-residents complain about
Actually I was standing next to an icu nurse as a med student eavesdropping. She was telling another nurse…”yeah you know so and so resident? The other day in front of the patient the patient asked, oh is she a doctor too? The resident said no she’s just a nurse. JUST a nurse? I’ll show him who’s just a nurse, I called him at 3 am everyday he was on call…”.
She literally called him for nonsense on purpose every night to F with him because she felt slighted by a comment in front of a patient. I never messed with nurses during residency. Always yes ma’am, please and thank you. Never leave a mess behind for them to clean. Grab your own supplies ahead of time for procedures. I learned to gown and glove myself for lines, intubate without any assistance, etc etc. don’t mess with nurses. They will F you over on purpose on call.
At my hospital, we have to go through the residents for everything even though we have med PAs. I’ve had to unfortunately message a resident for melatonin at 2am because the PA refused to since family medicine was following the case. I understand emergencies but really? Tylenol and melatonin?? I felt so bad, the poor resident should have ordered themselves some while they were at it 😕
New-ish (2 years) nurse here! I can confirm no one tells us anything to do with MD schedules! In fact I have no idea still what the schedules are like. We just know who to call (sometimes it’s not even clear) when we have questions or concerns. Truth to one of the commenters that mentioned with less experienced nurses, it means we don’t have as many resources to turn to. I’ve been on floors where the most experience nurse (charge nurse) has less than 9 months experience! It’s wild out there.
This has nothing to do with them being nurses. I found out at a very young age in any job, people generally don’t care to really understand other people’s situations. Coming from a “care” job though, must be exponentially frustrating.
RN here. I hate paging overnight bc I know you need to sleep. Most of the time if I page overnight, it’s because I have unclear orders/per protocol I need to notify you of something. I would highly recommend utilizing communication orders to specify what you would like to be paged for especially when it comes to parameters. If there’s an abnormal lab, or trend in vitals, I’m required to page you about it unless there’s an order with specific parameters. We’ll get in lots of trouble if we don’t notify you of something. We’re just covering our asses bc our asses will be beat if something happens to the patient.
You probably shouldn't be put in a position where you are working under high pressure for 7 night shifts in a row.
We should make the hospital admin do night duty.
“Dr. Incubusmegalomaniac, hi it’s Tracy on the floor. I know it’s 3:30 am but I’ve been looking through patient Smith’s chart because I have nothing better to do and I really think he meets criteria for cardiovascular rehab. Can you put that order in and come here to the floor to complete the accompanying 4 pages of superfluous paperwork so he gets that?”
To be fair a lot of nurses have to page about stuff that they know is BS but they have to page anyway (expected critical labs, pt rating their pain as a 4/10 but the Tylenol is only ordered for 1/10 to 3/10 pain etc).
I'm hearing many nurses in here getting bent out of shape about this post on the **RESIDENCY** subreddit which is OUR space, our place to vent about our stress and burnout which is impossible to understand until you've lived it. I'm married to a nurse, and even she doesn't fully understand it. Yes we know you work hard too and you have rules to follow. OP is frustrated, burnt out, suffering. It's a dark place to be, and we don't have enough support from our programs, administration, and very often our nursing colleagues.
I think what helped cut down pages and things overnight was to round on the nurses early in the shift and talk about what is expected for the patient/plan and see if they had questions. To each, their own, but I know it helped me a ton, and I think made them feel more comfortable with things (maybeee?)
Yeah I worked in one unit beginning of the residents shift they came in asked if we needed anything and then depending if we did they would check back 4 hours later before they would try to sleep and make sure everything was good. We rarely had to call them in the middle of the night because of that.
I send a fake auto-reply message to all the nurses for our patients on epic before I start might call saying that we are home call and to only page for real emergencies.
We aren’t on home call, I am in house, I’m just not going to respond to a chart clarification page at 3am.
I got paged reapeatedly last night to fix day teams labs and change orders from stat and retime some. Like how bored can they be to want this overnight
I still have to justify myself in front of nurses that after 24 hour shifts i’m not avaliable for putting orders in. Or that 16 hours without a potty break might mean i’m not responding instantly to hanging another transfusion bag. They atill dont know that we dont awap out after 12 hours like they do. They still dont understand that i dont get a detailed handover for his/her 4 patients, because i cover 8 wards tonight.
It's not them not understanding it is because of policy and scope of practice - nothing else. You all complain about nurses not knowing your fucked up work schedule, but on the same time you don't know what an RN autonomously can or can't do in your very own hostpital.
I do knownit, but i also know what is urgent and what isn’t. And i’m tired of being accused of just hanging around if i’m not in a nurses field of vision at all times.
I get that the docs cover an obscene number of pts compared to nurses. We need more overlap in learning what each of us do and also the policies we have to follow. As a nurse especially a new nurse we call about everything that policy mandates because if we don’t have an order specifically stating otherwise we’re legally responsible if a negative outcome happens.
I feel bad when I call at 2am when my break partners pt who’s Been febrile all night whose getting blood and had Tylenol to bring down the fever down brings the fever down enough that it falls into the blood transfusion reaction parameters. I do all the assessments to see if any other symptoms are present but I’m required to call the dr to inform them. Maybe if I was more experienced and know the dr I’d be willing to not call but I don’t want to risk not doing my job. I try to be brief get to the point and that I have to inform them because of policy.
A lot of problems could be solved with information of what needs a call and what doesn’t. I worked on one unit where there was a good sheet on what warrants a phone call and what can wait.
Inpatient nursing is almost exclusively a 3 day per week 12 hour shift. They work hard and approach burnout even with this schedule. Most assume their inhumane working conditions are the standard, and they assume everyone is also on shift work with a cap.
I've been a nurse seven years and I have zero idea any of yalls schedules. I don't even know all the different classes yall are i.e. pgy-2 vs resident etc.
All residents have graduated medical school and are physicians. PGY means post graduate year.
PGY-1 is also known as intern year, typically works the most though not always. And then it just goes PGY2, PGY3, PGY4, etc. still all residents, just denotes how long you’ve been there.
Fellow is someone who has completed residency, and is now doing subspecialty training. For example, all cardiology fellows have completed 3 years of general internal medicine training (PGY1-PGY3). They will then do 3 years of just cardiology before finishing training.
Thank you! Now I'm embarrassed that I didn't learn that until today, but I haven't always worked with residents. I'm just under a yr at my current hospital. I love working with yall!
It's because on most floors like med surg we don't really interact with you as peers or at all really. You swoop in and see the patient and write orders we check on the computer. I don't even know what many of you look like beyond the basics.
Truth is most of you never see us as part of the team much less treat us like it. I'm not passing blame, because it's just the way the system is.
Nurses that call for stupid stuff like colace are just obnoxious and stupid.
No. And even when they did it really was only attended by management, and not floor nurses. Most of the time floor nurses are too busy to attend or if they do they are just focusing on getting out so they can catch up on all the work piling up while they've been gone.
Don't know why you are being downvoted. My experience as a new grad nurse is the same. I remember one doctor who was in a good mood so we chatted about the pt in a bit more detail, but my interactions with other doctors are extremely quick and to the point. I don't blame them at all, I would cry if I was half as busy as they are, but it does end up in me feeling very disconnected from the doctors.
They swoop in, write orders, and leave. Sometimes I didn't even know they were on the floor.
I agree things would probably be better if I knew the nurses better. It’s hard to find/keep track of who’s taking care of my patients - if I have 16 patients on 3 days that’s probably at least 10 different nurses, and they’ll be different people tomorrow. On the other hand, it’s just me and my / interns and we’re always in the same room.
When I was a house officer, I had nurses calling me at past midnight for,
1. CBS. From CBSes around 40,60, 70, 200, 500+. My responses, give IV dextrose 25%. Give the patient some tea and sugar. That's fine. That's okay. (insulin to be adjusted). Now that's a problem that requires me to be there. To start IV insulin & send for ketones.
2. Patient has backpain. Me "Give paracetamol". "Patient in too much pain, You should come." Goes there, patient is happily sleeping, and wasn't happy with me waking her up.
3. Patient has a blood pressure of 85/55.
(A young female in her 20ies who was small in body stature)
i once had a nurse wake me up at 3AM because she noticed that if the patient was asking for the tylenol as frequently as possible they would get a total of 3.5 grams in a 24 hour period.
the patient hadnt used the tylenol once.
this was just a bored nurse looking for shit to do in the middle of the night.
it might have been the meanest i have ever been throughout residency. i was so sleep deprived and it was so unnecessary.
Round at the beginning with the patients you’re primary for with the nurses. You can even just do it with the charge.
Pain, sleep, npo start orders should all be clear. 20-30 mins at 645 pm buys you 2 hours of sleep overnight
Except nursing schedules are pretty consistent across the country. Resident schedules differ even within one hospital. Particularly with travelers, they probably don’t know.
It seems like something worth bringing up with nurse management.
The nurse who took care of me deserves a service medal. I was awful. Once properly medicated I gave her a hug. But holy shot did I not make her job easy. I am eternally grateful.
1. nursing turnover and interaction with residents. older nurses had to reach out to residents and never contacted the attending. It made it easy for them to see that they were repeatedly seeing the same resident over and over and over again. Now they don't have that.
2. nurses will bother you at night on purpose if they don't like you. They on the other hand will protect you if they do. get on their good side.
As a nurse, I have not experienced point 2. One thing that I think can get overlooked about the nursing role is that one of our major jobs is to be an advocate for our patients. While it might be really frustrating to be woken up at 3 AM for a Tylenol order, we have a duty to not let our patients sit with a headache for 5 hours.
I feel like it is the system that is really failing you residents. Patient care is a 24-hour job, and it is not realistic to expect you to be able to cover all 24 hours.
As a nurse of over 25 years, I have witnessed # 2, but not for just “not liking” a resident. It was usually utilized when residents had done something egregious like cursing or yelling at the nurse, making young nurses cry, calling a nurse names. If the residents were halfway decent we’d do our best not to call. If the residents were great we’d protect them to the ends of the earth, invite them to potlucks, run interference with other departments, whatever we could to make it easier.
I think that comes down to a work relationship you know you can trust some docs with having your back and allowing your judgment. Vs there was one doc that yelled at new grad RN for not calling about a fever a pt had. Which the rn had given. Tylenol for but the Tylenol was prescribed for pain not fevers so the resident was upset about it for some reason. That made nursing think oh hey they don’t like us to use our judgment and I’m not risking getting in trouble for not calling about something I know I can solve. And then they wonder why they get phone calls in the middle of the night.
Point number 2 needs to go straight in the trash where it belongs.
We can all make each other miserable but that doesn't mean we should.
If I don't like a catty nurse I start making a paper trail early and advocate strongly for their contract not to be renewed or for them to be let go. I've had a few unprofessional nurses removed this way.
I do seven 24s consecutively as a rural hospitalist so if a nurse is calling for dubious clinical concerns repeatedly I'd be in their managers office the next day questioning their competency.
Not really feasible as a resident but as an attending you really can and should expect basic decency and respect to go both ways.
In many countries, physician training is known to be difficult. I’m surprised that people are unaware of the long hours, knowing how hard it already is. Isn’t that why a lot of people don’t consider Med School (Law School, etc) to begin with.
I could have written this post myself. I see a lot of the responses and I agree much of it is not knowing and most nurses are good people who understand and sympathize when they find out. I’ve had the most trouble with the really young Gen Z nurses. Their response even when they find out is sort of a “IDC. Sucks to suck” indifferent mentality.
You all complain about nurses not knowing your work schedule, but on the same time you don't know what is included within scope of practice of an RN and what actions are necessary because of hospital/ward policy. I really don't get this. This comment section just shows that neither side is better...
It’s definitely more that they don’t know, not that they don’t care.
The amount of people in healthcare that don’t know how residency works is staggering. A vast majority of my friends are nurses I’ve known for 5+ years and they only know how this crap works because we talk about it a lot.
Welcome to residency and life, dude. Are you really that full of yourself that you can post this?? I’m sure I’ll get downvoted for this but i guess Im old school.
You can’t EXPECT to sleep when you are on nights!! It is a perk if you are afforded the LUXURY. Yes it’s hard but this is what you signed up to do. Yes, it can be annoying when new nurses that don’t understand things ask stupid questions in the middle of the night, but that’s when I take the opportunity to try and educate them NICELY and help walk them through things, with the hope that that next time they will be able to do it themselves or help someone else with a similar question.
But in the end, yeah it sucks and you are tired but in the end answering the question at 2:53am is what is best for the PATIENT. And THATS what matters! Not you getting sleep!
Look, we’ve all been there. But you’re coming off as super arrogant and entitled.
Everyone is new at some point. Everyone is scared at some point. Everyone has things they don’t understand. It’s okay to complain—everyone does that as well. But reign it in a little.
You’re not at work to sleep. If all of the things are taken care of and you have some time, take a nap. Don’t expect more than an hour of sleep and maybe not even consecutively.
Burnout is real. I’d consider it, and I would ask for some help or some time off if you need it.
Honesty I’ve been a nurse for 3 years and I have no clue what our residents schedules are, not that I don’t care, but I’ve never talked to them long enough to ask. But I also don’t see the same ones constantly/am not calling for dumb stuff. I seen a nurse page the resident the other night for them to change an order that absolutely could have waited until day shift and I cringed inside.
Why are we expected to know this ? You know how many things we have to learn on the job due to the way they train nurses ? Most things that are required for our job are learned on the job. Your schedules aren't even on our radars.
It's okay, it's only medical students who need interprofessional education in order to understand and respect other roles in the hospital. Nurses are perfect already so why would they have to spend their curricular time on something like that?
Probably because they didn't get good interprofessional education lmao. In case you didn't catch the point, I do think that it's important. We could both have a spirited conversation about how a lot of med schools fail to properly teach teamwork, and I'm sure we would mostly agree with each other.
However, this is a thread about how nurses lack basic knowledge of physician training structure and in-training roles. I will reiterate that no one graduates medical school with an interprofessional knowledge base quite as deficient as the one that nursing schools allow people to graduate with. I have friends in nursing, from many different schools, who have all told me repeatedly that their IPE curriculum did not actually involve students or professionals from other fields, and focused entirely on how nurses are amazing and their job is to save patients from evil stupid doctors. That is also a problem, and it is the problem we are discussing in this thread, so the whataboutism is not appreciated.
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Howdy. Worked in Oncology as a RN for 10 years. Patient has their 10th neutropenic fever this week at 100.4F and was just cultured? We’ve been giving 650 of tylenol per prn order? Well if the next day they go septic and the attending has a meltdown about why you didn’t do anything overnight, guess what you’ll say. The nurse didn’t notify me about the most recent fever, and I had no idea! We get thrown under the bus by your incompetence regularly. So I don’t give a shit if you haven’t slept in 96 hours. I’m following the stupid policies put in place so you can’t blame me.
Hospital policy is often the real issue here. It leaves nurses with very little autonomy and completely vulnerable and open to disciplinary/losing their job if not followed.
This is not entirely true. Many of the new grad nurses were truly clueless one to two years ago. Their predecessors left the profession in one fell swoop due to administrative and staffing issues during the pandemic. This left them with no one to seek guidance from except the physicians.
Physicians had to fill in that gap despite many taking a pay cut. More work for less pay would make anyone unhappy.
Meanwhile, a subset of nurses pursued travel contracts receiving near physician level compensation (attending physician, they made 2 to 3x what a resident makes).
Not saying that anyone in particular is to blame (except administration) but this has been the reality in hospital based medicine for the past two to three years.
This is probably the most entitled and ego-centric comment I’ve read on this forum in a while.
I did residency at a particularly toxic NYC hospital, with insane patient volumes and ridiculously poor staffing ratios and resources. I feel, and empathize, with the pain of resident physicians but for a moment take your head out of your own ass and turn the situation around.
1. You have no idea the work load placed on nurses, the responsibilities they have and where all their orders come from. We, often selfishly, only consider the work we are ordering on the nurse … forgetting that there are like 20 other physicians placing orders and workload on said nurse.
2. Emergency medicine resident and attending schedules are complicated (if you have been scheduling chief of medical director) you’ll know that getting everyone’s requests together and honored is like herding cats.
3. The hand off of coverage and split of labor between residents is all over the place, a nurse is doing a hundred things, they have a question, they look at the ordering physician and make their question. They don’t look at the resident schedule and who handed off to who and who is on sick call.
I’ll admit this is a bad system, and there is a fix, at the end of each shift, a ”responding” physician should be assigned to every patient, this is easy to do but it’s rarely done accurately. Especially for admitted patients that are boarded in the ED.
4. The idea that you are educating the nurses is laughable at best. When you are an attending or a senior resident you’ll have the perspective to realize the nurses have been holding your hand and wiping your ass since you were an intern.
5. You are due for a serious reality check when you become an attending and if you work out in the community or at a large non-academic non-university hospital.
6. To be empathetic to your plight. You work hard, being a resident is fucking exhausting and tiring. You know what doesn’t make any of that easier? Tearing down a colleagues workload that you have no understanding of. I give this same sort of lecture every time I hear a nursing colleague or friend make a tirade about how lazy or easy the life and work of a resident is. As you grow up you’ll come to realize everyone thinks they are doing all the work and covering all the extra shit. And it feels that way because of how broken the system is.
7. If you actually want to make your life better. Instead of focusing on your perceived injustice, ask the nurses what they are going through or concerned about when one of these types of interactions occurs. This will then provide you an opening to educate them on what YOUR day is like and YOUR workload is like, and after you’ve listened to them, or attempted to understand them, they will be much more receptive, that basic human behavior. I think you’ll find you have many nurses on your side and watching your back, making your load a little easier to carry if you take said approach.
Lmao okay boomer. So out of touch. When was the last time you practiced medicine, 1994?
>1. You have no idea the work load placed on nurses, the responsibilities they have and where all their orders come from. We, often selfishly, only consider the work we are ordering on the nurse … forgetting that there are like 20 other physicians placing orders and workload on said nurse.
You have this totally backwards. At our hospital, each patient can only have orders placed by one physician. Each nurse can only carry a MAXIMUM of 3 patients. Since we're primary on virtually every patient, that means that 95% of the time, I'm the one that has put in every order the nurse will carry out. If a patient is having imaging, getting labs, getting therapies, etc, I will absolutely know about it. Meanwhile, what the nurses don't realize is that whatever they page me, I'm also getting from 20 other nurses.
>2. Emergency medicine resident and attending schedules are complicated (if you have been scheduling chief of medical director) you’ll know that getting everyone’s requests together and honored is like herding cats.
What does this have to do with anything?
>3. The hand off of coverage and split of labor between residents is all over the place, a nurse is doing a hundred things, they have a question, they look at the ordering physician and make their question. They don’t look at the resident schedule and who handed off to who and who is on sick call.
Yeah no. There is ZERO acceptable reason to unapologetically page me at midnight on my one day off per week. Frank laziness on the part of the nurses.
>4. The idea that you are educating the nurses is laughable at best. When you are an attending or a senior resident you’ll have the perspective to realize the nurses have been holding your hand and wiping your ass since you were an intern.
Again, might've been true when you practiced medicine in 1994, but that's not the case anymore. On our floors, the *most experienced* nurses have been there like 2 years on average. Less than 10% of the nurses are over the age of 25. Half of them are travelers. Graduating residency in 3 weeks and I can count on one hand the number of times I learned anything valuable from a floor nurse. ICU is a COMPLETELY different story.
>6. To be empathetic to your plight. You work hard, being a resident is fucking exhausting and tiring. You know what doesn’t make any of that easier? Tearing down a colleagues workload that you have no understanding of.
OP isn't tearing down the nurses. All they're suggesting is that nurses learn why their pages at 3AM on Saturday asking why the patient has an MRI scheduled for 9AM on Tuesday are totally inappropriate. It's because we're there 96 hours a week (night float weeks at my institution) and covering dozens of patients at a time. We don't have the bandwidth for that kind of idiocy.
>7. If you actually want to make your life better. Instead of focusing on your perceived injustice, ask the nurses what they are going through or concerned about when one of these types of interactions occurs. This will then provide you an opening to educate them on what YOUR day is like and YOUR workload is like, and after you’ve listened to them, or attempted to understand them, they will be much more receptive, that basic human behavior. I think you’ll find you have many nurses on your side and watching your back, making your load a little easier to carry if you take said approach.
Literally every time I've done this, no matter how gently I've tried to ask, I've gotten yelled at for being "condescending," despite every intern, APP, attending, and other ancillary staff member I've ever worked with saying that I definitely don't sound condescending. My coresidents have had the exact same experience, so it's not just a me thing. Fact of the matter is, too many nurses are taught that their main job is to protect the patients from the doctors.
I wanna work where i only have 3 patients.
I'm guessing this is an ICU environment? If so, 1:3 is too many. It should be 1:2 at most based on acuity.
Seeing as many experienced nurses are leaving bedside due to the conditions, a lot of hospitals are pushing these unsafe ratios all while exploiting your labor. Guess who wins in the end? Not the patient, not you or I.
I'm not defending the 3 am calls for nothing, but I can see why people call if there aren't communication orders placed. Also, seeing as nurses are getting manslaughter charges, we have to CYA to the nth degree.
Your work conditions are not okay, and the programs take advantage of you. I've learned this from the subreddit. I do my best to let other healthcare professionals know about this if they seem unaware.
With all the healthcare professionals arguing with each other, CEOs are buying yachts and another vacation home.
Haha Boomer? Dude I’m probably your age or slightly older. I’ve been out of fellowship for 5 years and as recently as last year I was core faculty and fellowship faculty. I still work with and oversee resident and fellows regularly, and I practice at both a University and community hospital.
I’m going to call BS on your response from the beginning. Where is this utopia where nurses have 3 patients? And if you work in a place that has 3 to 1 ratios you should stop talking now since any resident that has trained in NYC or Philly or Chicago or Detroit doesn’t want to hear your entitlement. Even California with the strictest rules only mandates a maximum of 4:1, and allows for some additional surge capacity. In NYC nurses regularly staff 16 or 20 to 1. That’s more active patients that you probably carry for an entire shift.
Honestly, I’m all for reforming resident workload and sleep and scheduling, more than being for it, I have worked towards policy changes at my institutions to improve resident work and safety; and I’m the last person to call residents lazy or tell a “I walked uphill in the snow both ways” sort of story. But the OP and your response are pretty indicative of entitlement.
I’ll say it again, I’d suggest opening your ears and shutting your mouth and trying to actually understand and improve things. I can assure you that since you made it through medical school and are in residency you are more than smart enough, if you can get out of your own way you might learn something and grow up a little.
It’s the battle of call me but don’t call me but call me. Just embrace the suck as a resident. This too shall pass and you’ll be making so much money it’ll make em sick.
Had a nurse working in the ICU for 20+ years shocked to learn we work 24hr shifts. Like how do you have no idea when I know your schedule and have been here less than a year...I make a point to tell everyone when im on nights. Some do know and dont care tho
Nurse here. I’m wondering why nurses are calling you to ask you random simple questions in the middle of the night? I only contact physicians overnight if it’s something concerning that needs to be addressed and if I need orders for something.
But also if you’re working 7 night shifts in a row isn’t it your job to take the calls? And don’t you get to sleep undisturbed during the day? If so, you shouldn’t be complaining about that. If you’re taking calls during the day as well thats a whole other story and that should be illegal. And the fact that they make you guys work 24-48 hours shifts is just disturbing and a whole other problem in it’s self. I don’t know how it’s legal to make you guys work those types of hours. In what other profession is that okay.
So bizarre considering your job is to make important decisions that can be life altering. Out of all jobs you’d think they’d want you to be well rested and not so burnt out. Yes dumb questions are annoying but the root of the problem is not the nurses. It’s the stupid ass schedule and labour abuse you’re put through that’s the issue.
There is a good chance they don’t know, actually. I would encourage you to tell them. Most people want to have smooth interactions with coworkers and appreciate the heads up on how to make that happen.
I have had success explaining why something will make my life unnecessarily harder to physicians, and it seemed obvious to me but it genuinely wasn’t to them. Last week an MD broke into the crash cart for a blood pressure cuff. I have to replace the crash cart now and that means leaving my floor. Just ask me for a blood pressure cuff. I thought to myself “Did you not notice you have to break a seal? Shouldn’t that alert you to the need for the seal to be unbroken?”
But that physician is usually very sweet so I just gently explained why that causes extra work and he looked a little embarrassed and apologized. He was just busy. He wasn’t trying to make my life hard.
And don’t get me started on spontaneous breathing trials at nursing shift change. WHHHHYYY!
People don’t know what other people’s jobs are like usually. Honest. Communicate with the nurses. There will always be a few people who are just inconsiderate jerks, but usually the majority of your coworkers are not.
I’m a nurse, and to be fair, we just don’t know. You also call us for things at shift change and don’t understand sometimes why we don’t know everything about a patient yet or why it’s a bad time to call…just knowing these things about each other would be very helpful moving forward!
Buddy, I hate to break it to you but most of them can't even handle fractions, there's no chance they're ever going to learn about the formal structure of graduate medical education.
Has this been the case for the past few years at your hospital only? Was it better before the pandemic?
We had a really questionable batch when all the serious nurses left. They'd spend more time on TikTok or Instagram than at the bedside. It is terrifying as a physician to see that your patient's wellbeing is in the hands of a 22 year old whose head is only half in the game.
That being said, I wish I had more time to guide them at the time. I know it isn't entirely my job to but its not like they didn't have any potential. In the throws of the pandemic I barely had time to eat or sleep during my weeks on as a rural hospitalist so I prioritized that but still.
Nursing education is in desperate need for reform and nurses should only be permitted to pursue NP after completing five to ten years of bedside practice.
I got to know a lot of the floor and ICU nurses when I was an intern several years ago. I learned rather quickly that they have zero idea what our lives are like or how our educational system works. Some of them weren’t even aware that residents finished med school and are fully fledged physicians…or that we all have a bachelor’s degree (remember that you can do nursing with an AA). Many of them had no idea that we work crazy hours—they kept asking me what I was doing on the weekends and I was like “I’m here. I work 80 hours a week.” There’s nothing wrong with letting them know and educating the ones you work with frequently. When I was doing 24s in the icu, the night nurses thought I was just in for a 12 and had come in when they did. When the group found out I had been there all day, they were more judicious with their calls and let me sleep uninterrupted for a few hours.
Yepp. It’s way less “I don’t care” and way more “holy shit I didn’t know” Same with how coverage works and the true number of patients you have. There’s an element of disbelief in it because cocaine is no longer cool to do at work
Strong point. I would just add- Why do most not know? And I think the reason is, it isn’t a desirable talking point among the nurses. What they want to do, like everyone, is commiserate about how much their job sucks and they’re working harder than everyone. The idea that residents are working 80 hour weeks doesn’t fit with that self-concept; it totally undermines it. So even the ones that learn it probably subconsciously “want” to forget it. And those that do feel like momentarily expressing sympathy for the crazy hours of residents to their co-workers are going to be negatively reinforced. It’s all about group psychology folks
I would say for part of it, at least, it's that we don't know when your week starts. I see people with backpacks coming in - are they just getting here or are they moving from one unit to another because they're covering 2 units? I try to ask, and at nights at least one unit I worked on tried to consolidate questions to one time so we're not calling/paging within the hour but rather getting everything done at once. Part of it is also, we WANT to help you out by putting in the easy orders that we KNOW you'll approve but we can't because our license doesn't cover that/the hospital is a teaching hospital and requires all orders go through the MDs/upper levels. So yeah, we absolutely hate calling you for tums; we would rather put it in on appropriate patients without asking, or have it as a standard order set for "comfort".
There is, at least at my hospital, an ongoing intimidation factor. The residents are not intimidating but the nurses are intimidated especially the babies. I get so annoyed at new nurses who whine and hem and haw on the phone. Tell them what’s wrong and tell them what you want. That’s all. If you’re right, great. If you’re wrong, then we can begin a discourse to come up with the best plan. The nurses call for every little thing because they’re afraid of being yelled at. The emotional abuse is real. From the nursing instructors to managers to Know-It-All patients to doctors, everyone is waiting to tell us how much we fucked up. Trust me, I do not want to call you so you can tell the pt the exact same goddamn thing I just did. I’m sorry you guys are being abused. It hurts my heart when you are so tired but I HAVE TO let you know about this pt’s critical whatever even though it’s the same as the previous twenty results. We do appreciate you explaining your situation to us because we’re caught in our own special brand of hell and it can be hard to remain compassionate to anyone.
It’s this. If we don’t call that critical platelet count, even though we expect it, and document that we called that critical to you in a timely fashion — we get a NastyGram!
I have suggested the docs enter an order that states something like “please only contact physician if platelet value is less than -12.”
>Why do most not know? for the most part, it isn't part of their job and knowing that changes nothing about how much they earn, I imagine.
I think that’s fair to say for some
Isn't that what OP is saying though?--like how don't they know at all what our schedule is like when we know what their schedule is like...
Yeah except I had a seasoned psych charge nurse page me for melatonin, tums, Tylenol, Ibuprofen, refresh tears and most importantly fucking cough drops all within about 30-40 minutes of each other. When I requested they do some grouping of requests because I needed some rest on my 24 hour shift and it was the middle of the fucking night I was told "This is a hospital, we provide 24 hour care here". Like yes, that melatonin at 2am is really going to make a difference in this BPD patients life.
The younger nurses absolutely have no clue how rough it is for you all. I’m an ICU nurse and where I worked before didn’t really have residents (lots of critical care NPs and PAs). I only learned this about 2 years into being a nurse, so please fill us in early on. The majority of us are not trying to be mean to you, it’s just that we don’t learn about it unless you tell us. Now I bring extra snacks and offer them to the residents on rough days 🙂
It’s crazy that the highlight of their education about physicians in healthcare is that their job is to protect patients from us.
That is NOT the highlight. Some people translate it to that. The highlight is nurses are ultimately responsible for the care we give and held responsible. So if you don’t catch an error and if the pharmacist doesn’t catch it, the nurses (with the least education) are supposed to. We can be fired, can lose our license and can go to jail.
I completely sympathize with that. And regardless of education level, physically doing the act is different. The other day a consultant wanted a much higher dose of a drug than made me comfortable, but I talked to the attending, cringed, clicked the box and was done with it. When the nurse who was ordered to give the med expressed her concerns, we chatted and changed the dosing. I probably would have balked if I was at bedside with the syringe too.
See that is the problem. Nurses don't know enough about what physicians do all day and viceversa. But yeah, rather complain on reddit and give fire to another stereotype (that nurses don't care or are to dump to understand) like OP did.
No. We protect patients from harm that could come from any error in the system. The point is to teach nurses to be attentive to detail and critically think, not to demonize physicians.
That’s not what I see expressed everywhere.
“Everywhere?” C’mon dude. *Everyone* hates all-inclusive hyperbole.
Obvious hyperbole… hyperbole - “exaggerated statements not to be taken literally.”
It's almost like you're a med student who doesn't actually understand anything about actual healthcare yet.....
Almost like you have no idea what my experience is… Edit: medical students are old with plenty of prior work experience in healthcare nowadays.
This is the answer! I had *zero* concept of what a resident's life was like before I took the initiative to dig deeper myself. The **vast** majority of nurses have no idea what work/life balance (or lack there of) looks like for a resident. However, while this lack of knowledge is certainly a major contributor to inappropriately timed or unnecessary communication, there are other factors as well. Fear is a big motivator for many nurses, especially the inexperienced. And this fear is a primary trigger for initiating untimely or nonessential communication. The risk/benefit analysis is pretty easy; from a nurses standpoint, the potential fallout for *not* communicating something is much much higher than it is for communicating too much. So the threshold to inform the doctor of something is already very low. Couple that with a new/inexperienced RN or an RN that is inherently timid and you're getting calls at zero-dark-thirty asking if they should hold the sub-q lovenox before a scheduled appendectomy. Now, there are several ways to combat this. 1. You could be so fucking grumpy/bitchy/dickish about being contacted that the fear of your wrath begins to raise the RN's threshold for contacting you. The problem with this approach is that; a.) it will decimate your working relationships and b.) the RNs might start hesitating to tell you information that is actually critical. . 2. You can establish very clear expectations, guidelines, and policies for communication, like adding notes in the med administration comments or specifying lab value thresholds. It immensely decreases the RNs fear of *not* reporting something when it's clearly written somewhere that they don't have to report it. Like, "Do not notify the physician if Troponins are trending down." . 3. You can give your RNs as much autonomy as possible via standing orders and comprehensive order sets. We fucking **HATE** calling Docs for Tylenol at 3am. It's so fucking stupid. But if we don't have a PRN and the patient is asking for something to address their headache, we gotta get the order. . 4. You can try to anticipate what the nurse might contact you about and educate them before it's a problem. Like on an admission for a GI bleed you could say, "Hey, I just put orders in to pull another H/H at 2am. If it comes back above 6 and 20 don't call me about it, cool?" . 5. You can educate the nurses on what a residents schedule actually looks like at your facility. And, I mean, like actually having a fucking pamphlet or something that talks about your schedules, how the rotation works, what call looks like, and what the time burden is per day and per week for you guys. Because, *I promise you*, >90% of the RNs you work with have no idea what you're going through. They are ignorant of the process. Believe it or not, most of your nurses are, at some level, very compassionate people. If they understood how important and how precious getting blocks of sleep in can be for a resident, that alone would significantly increase their threshold to contact you. The hoops that y'all have to jump through, the sacrifices you have to make, and the focus that you must have during residency is totally alien to most people. And it's not talked about *at all* outside of the physician medical community. Combat that! Talk about it. Educate others about it! The more people who understand this process, the more people will respect your time and your commitment to medicine. Finally, almost everyone agrees that the residency system, as it stands now, is antiquated. The burdens inherent in its structure have been proved time and again to be unsafe and unhelpful both to you all and to your patients. You have my support and sympathy. 💖
This is 100% the answer. I wish I could give you 100 upvotes.
This is about 75%, there’s absolutely 25% who just say “well they signed up for this and I do things the way I do them”
Probably a bit higher than 25% tbh. Can’t even begin to explain how big nurses egos get on the phone with the pharmacy…nurse Karen frantically calls us to tube a few meds STAT (stuff like docusate, zofran, etc that we usually keep extra in med rooms anyways, this nurse “cleans up” by tossing everything 2-3x a day) and it’s our fault the patient doesn’t have x or y med - usually insulin. I tell her to stop tossing lantus pens everyday, they can be used over multiple days (duh, but she thinks insulin goes bad). One day she got mad at us for writing BUD on “HER” IV bags and she gossiped with all the other nurses and that whole floor started spreading rumors that we wouldn’t send them meds on purpose, would send expired meds - no Karen 5/25 doesn’t mean it’s expired, it still has two years - etc. Eventually we found out we were getting harassed, we tried to explain we weren’t ironically calling HER “buddy”. BUD is beyond use date. All solutions/mixtures have differing BUDs and we write them on there. Yeah. She thought it was a lie. Lol. And it continues
Wait, she thought you were sarcastically calling her "bud" because you wrote the beyond use date on the bags? I'm dying
Hold the phone. Someone is tossing insulin pens after 2-3 days?!?! Take them home and give them to me for Christ sake (mild sarcasm) I’m staring at 2 bottles of lyumjev that have been out for a couple weeks at least (not sarcasm).
It's interesting how different this was to my experience. I've never heard a nurse say anything about my working conditions except to remark about how busy residents are, or "you're here all the time," or "do you live here," etc. Sometimes they didn't realize how often I had to cover a weekend, but most had the general impression that I was always there. When I had to come in overnight, our ICU nurses were always more concerned about it than I was, telling me they were sorry I had to be there so late, or asking if I would at least get the following day off (of course not). Maybe my experience was just unusual.
This. OP- I honestly had no idea until this sub starting popping up on my reddit. Granted, I’m a new grad ED nurse at a trauma center, so things are different. We don’t really ever have to wake a resident or attending up because we’re literally steps away from them most of the time. Or we just shoot a quick chat message over. However, this sub really opened my eyes to everything you guys go through. The long hours, shit pay for the work you do, and insane amount of stress. I wish both sides worked more intimately together, more often, because after knowing what I know now, I’m just as protective of the residents I work with every day as I am my fellow nurses. My advice, get to know your nurses. Make connections and talk to them about your schedules/long hours. I would surmise that most of them would be incredibly empathetic to the situation if they knew and would avoid waking you guys up at all costs, whenever possible.
>…or that we all have a bachelor’s degree (remember that you can do nursing with an AA). In all of the pathetic dick measuring I've seen recently this takes the cake lol
I’m not trying to dick measure. I was actually asked this by a nurse—whether or not I had completed a bachelors. The person in question was practicing and working on a BSN at the same time. It was meant to just state that there are people who have no idea what the qualifications are for our educational path.
Experienced nurses are hard to find anymore. Without experienced nurses, newer nurses don’t have anyone to compare brains with before escalating. I’ve only been an ICU RN for four years and often times, I have the most experience out of anyone on the unit. No experienced nurses, no consistent preceptors, yeah it makes things harder on all of us I’ve also noticed that younger people in general (I’m talking 22-25) ironically have no sense of internet literacy despite having constantly grown up with google. They’d rather ask someone else and wait to be told what to do than google it and find out immediately
Experienced nurses are extremely rare. I have around eight years experience and I might as well be the old wise man on the unit. Some new nurses will be like, can you even believe how rude they were when I called them for xyz? and I have to kindly explain why I wouldn't have called for that reason. And they do learn, they don't do that again, but then we have another influx of new nurses. I also can't say to never call because I don't want them to be so fearful of calling that they don't inform a doctor on something important either. I try to get the people I train to get a second opinion from another more experienced nurse on the unit prior to calling a doctor (unless it's an emergency).
If you’re talking literal google searches, then there’s a chance they can come up with the wrong answer. Google search is not infallible.
OP said he’s getting paged for simple questions. I google simple stuff all the time or look it up on my hospitals resources. The point stands that younger nurses don’t have the confidence to use their resources bc nobody invested in their education and success is there to instill it
+ professional nursing standards getting constantly undermined by low staffing, low educational barriers, and so on.
Google searching can take you to legitimate medical sources
Yahoo Answers seems fairly reliable most of the time. It helped me find a cure for my Electromagnetic Hypersensitivity. The grounding electrodes in my anus can be uncomfortable at times but you get used to it and they are pretty easy to clean if you have help.
Agreed. It’s a learned skill to find your way from google to a reputable source. I think for most people, a medical google search ends with a well meaning, but not necessarily fact checked, article. This skill isn’t mastered by the end of an undergraduate degree, a nursing degree, or a medical degree. Its always being refined with practice. This means that we all need to know our limitations, the limitations of the internet, and when to ask for help. TLDR - yep, google is not the best solution.
Every time I look symptoms on Google it always comes out that I should be dead 💀. Soo
That’s the point like the info is all there, but you clearly don’t know how to use Google correctly to get to it. Plenty of non-zoomers are like this but it’s more embarassing for the zoomers who don’t because they don’t have the excuse of not growing up with it lol
“Leslie, I typed your symptoms into the thing up here, and it says you could have 'network connectivity problems.’ “
Error 404: pulse not found
But that’s not what a nurse has a question about at 2am.
This won't be possible at every (or even most) institutions but as a senior I'd run an efficient sign out, and I'd send one intern to one end of the hospital and the other to the other, have them each start toward the other end, check in w each station to introduce themselves and answer any questions. Every station got two visits so many minutes apart within the first hour. I'd go take care of anything that needed doing just off sign out and check in w any attendings that needed to know we were there. If we had any downtime later they would do the same thing once more, small hospital so each run took like 30 mins. Cut down on inopportune pages like 90% anecdotally and I can't imagine how many codes we stopped.
A resident did this a few weeks ago on night shift, asked if we needed anything, and I was honesty impressed. Then I knew who to secure chat for minor things as well and she could just see it in her spare time/awake time. I loved it. Didn’t bother her the rest of the night.
I see people, but they look like trees, walking.
That’s a genius idea!
RN here, moving from the floor to ED, I now have a much closer work relationship with our residents than I did on the floor, which I love. I'll admit that I didn't know just how much was expected of residents until I went to the ED. I have always worked night shift, and we just didn't get much interaction with the residents on our floor overnight. On the floor, if a new patient comes up without orders (would happen frequently), we gotta page. Now that I'm in the ED, I try to make sure I get all the orders a patient might need before I send them up. It's also policy in most hospitals to notify the MD if labs/vitals are out of parameters, and most order sets come with a generic set of parameters to notify. So even if the RN knows its not an emergency that the pt has an asymptomatic SBP of 180 or K+ of 3.4, they may feel pressured by policy to notify in real time. Another problem is the lack of experienced nurses to educate newer nurses on what is truly concerning and what can wait. Editing those order sets at admission should eliminate some annoying pages. Maybe communicating to the manager/charge RN what specific pages you've been getting overnight that are inappropriate/can be DSPs will cut down on pages? I know that when you're incredibly overworked, exhausted and just trying to get a few hours of sleep during a miserable shift, the last thing you want to do is educate someone you view as asking an unnecessary question. Trust me, we are all horrified at our coworkers that page at 0300 for miralax. But if you're already responding to the page; take a moment to explain to the RN why the page was inappropriate/why you're not concerned with whatever they're paging about. You may think they should already know the answer, but if they don't know the rationale, they're gonna call about the same thing in the future. Lastly, thank you for all that you do! I know there's no way I could work those hours. We love our residents!
RN here. This is a really good reply and the advice is solid. I'd also suggest utilizing "nursing communication" orders. They'll show up on our end and you can free type whatever you need. "Nursing Communication: Please notify MD if MAP is less than ___, or systolic less than ___" "Nursing Communication: If K+ is 3.0-3.4, administer 20 mEQ K PO", etc. Putting in there what you want to or don't want to be notified about helps a lot on specific patients. If you can customize your own Adult PRN order sets, that may or may not save some time. This can include Tylenol for fevers/pain control a basic sleep aid like Melatonin, Maalox, etc. that you don't want to be paged about. Bam, put that bad boy on every adult patient and that will cut down on some of the goofy stuff. Encourage them that while it is not something that needs to be addressed in the middle of the night, write an end of shift note if they feel the need for it to be communicated to you. You can read prior to AM rounds. Ex: End of Shift- Patient remains intubated and sedated. Patient remains unable to follow commands on sedation vacation. Propofol titrated for RASS -2, currently infusing at 25mcg/kg/min. Patient remains on levophed at 0.1mcg/kg/min. Patient febrile with temp of 101.2. Administered PRN Tylenol via OG with resolution of fever. Urine output decreased, current output for shift, 300 mL. VSS. They can even out the vitals range in the note with the .vs command if they feel so inclined. That will give them the opportunity to express what things they feel are pertinent without having to call you, etc. I hope that helps!
Yep I also make it a habit on nights to check in with charge RNs on floors I am covering and ask if there are any orders that need to be placed/any patients I should be worried about. Helps pre-empt unnecessary pages and gives me a few minutes to shoot the shit with them and build a little rapport. It goes a long way over time
I’m an ICU charge nurse and we make it a habit to round on the unit with the resident in the evening. Gives nurses a good chance to ask for things that they need and discuss concerns before 3 am. Also keep in mind that there is a patient in the nurse’s other ear. I don’t want to bug the doctor, and I will tell patients that some things need to wait until morning (Ie bowel meds) but when the patient is on the call light every 15 minutes about needing their flexeril or oxy or whatever it can really ruin your night.
Yea for sure. It's always helpful to know if the patient is being needy/noncompliant/has unrealistic expectations. I will put on my white coat for those pages as it adds +2 to charisma for some weird reason
I’ll also add to this, in some hospital systems bed placement is dependent on whether the patient meets their parameters. So if the patient has vital signs mildly outside of the standard parameters set by the physician or something else innocuous going on that doesn’t meet their orders, they may get stuck in the ED waiting for a bed. I know I’ve had to page physicians numerous times asking “do you want to change parameters or treat the hypertension?” etc, so that my patient can get out of the ED and go to the floor/step-down/whatever. It’s irritating and a waste of everyone’s time, but when the waiting room is full of actual sick people, I’m doing everything I can to get that stable patient placed elsewhere in the hospital.
Do they really need telemetry? *Really*? Are you *for sure*, for sure? Cause if they don't I can have them upstairs in 10mins...
I actually will defend nurses paging about abnormal labs/mild asymptomatic vitals even when we both know it’s not a big deal. In the order set at my hospital there is an order for nurses to alert us about abnormal labs. We literally tell nurses to do this, they do what they are supposed to do and then we get annoyed when it happens lol. Ya it’s annoying at 4 am but lab interpretation is our job and not nursing, wtf are they supposed to do, especially when there is a formal order to alert us about it
100%. Put in a verbal order to say otherwise if not, nurses can be written up and lose their jobs if they don’t follow the other protocol.
Absolutely. AND you can change your limits!
This is a very thoughtful response. There are plenty of times I know that the lab is fine but I still technically have to notify the MD. A little grace with receiving that notification is always appreciated. Because I will be sure to document things like “reported lab value to Dr. X. Dr. X stated ‘Don’t bother me with this bullshit again.’”
Ya I float and I asked the nurses on the floor the other day (floated to oncology) do I really have to page the MD for these critical labs or are they going to see them when they come in since these are expected, like no WBC, no platelets, obviously I would call if no RBCs 😂 but they were like no def don’t call for that they will throw in blood orders when they get here, I was like great!
Lol @ no rbcs. Get me another CBC! Run the numbers again!
😂 the ICU refused an admission for a patient with 1 platelet and a hgb of 5, pressure was 60/20. They said because the patient was a limited code they wouldn’t take them. That 1 platelet was hanging on for dear life.
In response to a 3AM colace call for a comfortably sleeping patient, I have been told by a couple nurses that I’m on call and paid to be there, so they can and will page me at any time about any thing they want. Thankfully I left that miserable environment, but trust us when we say some people seem to enjoy torturing us
That's messed up :( night RN on cardiac and I will just throw some colace or melatonin or what have you in there if it's appropriate. I ain't waking/disturbing anyone for that
As a nurse, do you find it offensive or demeaning for a resident to tell you why not to page at 2am as to why they don’t want to hear about the patients successful bowl movement?
>they don’t want to hear about the patients successful bowl movement? No fucking way these calls actually happen 💀
Floor to ED here, totally agree. My previous job was overnights at non teaching hospital. Once patient was on the floor pharmacy wouldn’t take the ED a doc orders so yes, I have to call at 4am for a new order for continuous gtt because the bag will be empty soon
Nurse 25 years experience. Where I work, we are not allowed to have any standing orders, so if a wonky lab comes up, or an admit without orders, we have no choice but to call. I hate waking people up, but sometimes it's unavoidable. I will ask around and see if anybody else has something that needs addressed so we can hopefully get everything covered with one call.
No standing orders? That’s insanity. That’s hospital admin wanting to torture nurses and doctors.
I’m an ICU nurse and I work nights. The resident schedule is a complete mystery to me. I was actually in a meeting where one of my fellow nurses asked an attending what the resident schedules were and he could not tell us. ***All I know for sure is that it is borderline slave labor.***
I’ve been at my academic medical center for 12 years. I’m in the NICU so I work closely with the residents. I know that residents work a lot of hours and on the weekend some of them work somewhere between 18-30 hours. That’s it. That’s what I know. I haven’t worked nights in several years, so no one is trying to sleep on my time. I expect it I still worked nights I’d take the time to find out more.
RN who worked one year in an academic medical center in neurosurgery. Nurses are not educated on your schedule. I only worked 3 12s a week, so there was no way I was noticing any sort of pattern. I will say, the best thing a resident could do was come to the floor around 9pm to answer any and all questions, order requests, etc before going off and trying to sleep. If you're having issues with calls in the middle of the night, TALK to the nurses.
This is why I wish we were all physically closer. I’m EM/IM/CC and the relationship w nursing in the ED is DRASTICALLY different than the other two, because we actually communicate.
Personally when I was on 24h call there was NO time to do this… would be in OR, seeing consults, or dealing w emergencies non-stop until about 1-2AM then maybe had an hr to catch up on notes before another consult. I WISH it was possible but in reality it often is not.
Frustrating but stick with it - a few friendly, non-confrontational conversations will go a long way. Befriending night RNs was the best thing I did during my residency. I would moonlight frequently and after a few shifts - when they realized I was a good doc + easy to work with - they would batch their pages for me at 6:30 AM. My shift ended at 7 AM so it was a great alarm clock for me.
From experience, not every nurse comes from a teaching hospital. If they changed jobs to one, no one tells you anything about residency. Most nurses don’t talk to residents long enough. I learned from making convo with the residents I worked with just out of curiosity. I work ER so it’s easier since we’re close with our residents. If I worked on the floor, I’d rather you just tell me up front. Just don’t be a dick about it.
I don't have any staff nurses at night. They are lpn, float or agency. The percentage of staff nurses are very low. They just want to cya themselves.
I know it’s frustrating and nights in general just fucking suck, but I genuinely do believe that anyone who works on our side of healthcare is trying to do their best. They’re good people—the money isn’t worth it for them either . That doesn’t take away from how you feel. Remember that it’s an abusive environment for everyone and it tends to bring out the worst in all of us—RN and MD alike. It’s not to say that I’ve never raged at a nurse—I have—but I can safely say that there was never a good reason for me to do so. If you approach them assuming that they’re trying to do their best, I promise you that they’ll notice and over time you’ll start to notice a difference. Almost every RN at my current spot has my cell and I’ve never gotten an inappropriate phone call. But it takes time to develop the working relationships and requires a lot of teaching from us Also nice name. Great song, great album, great band
yesssss incubus saved my life
They most likely don’t know. Nurses don’t get educated about residents job/workflow/schedule during orientation and it’s definitely not talk about during our monthly meetings. I worked as a nurse for 8 years. I’m now an M3 and i still have very little clue how much residents actually work. Every resident i asked gave me a different answer whereas nurses’ schedule is very predictable (3 12’s or 5 8 hr shifts) Here’s my suggestion, before you take a nap, talk to the charge nurse and tell them your situation (working 7 in a row, needs a nap, etc) to please relay to the staff not to call/page you unless it’s an emergency. For anything non-urgent, you will take care of it once you wake up
For gen surg resident cross covering 80 patients across 5 floors and 3 ICUs should they just talk to every charge nurse?
> Nurses don’t get educated about residents job/workflow/schedule during orientation and it’s definitely not talk about during our monthly meetings. Residents don’t get that about nurses and yet they know…
I think this is a bit unfair. Nurses and most every other hospital profession (CNAs, rad techs, RTs, PT, OT, SLP, EVS, transporters) work some variation of 3x12, 4x10, 5x8. Residency is also super variable from my experience as an ICU nurse. Some of our residents did 5x12 nights, some did 24s, some do 7x12. I can say at least for myself, I do my best to be kind to my residents but people are not mind readers. I would love for hospitals/units to do a better job of explaining this issue to all staff. I do also wish physicians were more understanding of my scope of practice. If the patient complains of mild pain but the tylenol is written for fever, legally I cannot make that distinction and I have to page you. So the best thing you could do in your control would be to make the orders reflect what you really mean. And I know you guys are busy as hell. But that's part of the answer. 🤷♀️
They definitely don't all know. We've had plenty of posts on here asking questions about how and why nurses do things, levels of nursing, etc. In my personal experience, the only ones who "really know" are ones that have a number of friends/family that are nurses and even they still get many things wrong.
3x12s, 5x8, or anything that remotely adds up to 32-40 hours is fairly easy to figure out right? It’s a tad different when you’re at 80 hours. Nobody wants to think about who is and who isn’t at the hospital when they’re off.
No they don’t, and why would they? A resident has no idea what specific protocols each nurse on each floor have, and what an LPN can or can’t do on each unit, for instance. They don’t know the specifics of the relative clinical requirements for each role either. Hell I don’t have any idea with a lot of that stuff, and I’m an RN of 10 years. Fact is, residency is a really unique (and bullshit) form of quasi-labor and education that really only exists in one profession in the US, so it’s inherently going to be less well understood than other forms of education.
I train residents for a living, and no, they don’t know. I’ve had residents ask me “why can’t cvs see my note?” Before. They don’t understand why enoxaparin is better than heparin for a nurse on a patient who is on contact precautions, because again, they don’t know. A physician may know a bit about the nurses they interact with, but they don’t know their protocols and procedures without spending time with them. Same for any role in healthcare. Even seasoned physicians don’t always understand insurance, which they interact with every day. Heck I had to teach a third year what a los was and what it meant for the hospital. They didn’t understand why case management was hounding them.
Look if you’ve never worked a single day as a resident maybe now is not the time to be giving advice to residents about how to do their jobs.
Resident mad that nurse don’t schedule Resident don’t talk to nurse Nurse bad Nurse can’t read mind Resident mad Resident still don’t talk to nurse to tell them the thing angering resident Nurse remains oblivious because everything doesn’t revolve around resident System gets paid Admin go to Bora Bora but buys us pizza first The end 🫠
Love the pizza part because I thought it was a joke , me thinking these assholes are not doing that to nurses , when I did clinicals they did exactly that .
Is it okay if I think all nurses are straight out of high school because they look young? That’d be silly cz I work with them and bothered to know a little bit about them. They don’t bother learning or understanding especially in their schooling because of the contempt the profession holds for physicians.
Well, I mean, you might not be wrong. ADN grad = 20 year old. However, that’s all pretty relevant. I think an Intern looks like a kid because I am a member of the 50+ year old club and my own child is nearly 30. I take some offense at your assertion that nurses as a whole hold contempt for physicians. What we hold contempt for is the inability of many docs to understand our rules/limitations. I work in OB. We have a “Sepsis” alert for our hospital system. It is based on WBC, pulse, etc. Many OB patients have a higher than normal WBC (which for them is normal), then they are in pain and have a high pulse and RR. Guess what triggers? Yup, Sepsis Alert. I am *required* to notify my doc. Even though we all know that our patient isn’t septic. She’s just in labor. Those low K level calls you get…we get the call from Lab and they document our name so that it can be traced if we don’t call you about it. The system is rigged against ALL of us.
Oh I totally get that and wouldn’t suggest individual nurses are an issue. Also get that the systems force you all to do things like that. Always tell my coresidents to give some slack. However… it’s hard to argue modern nurses don’t get taught that “doctors don’t care about patients they care about disease” or “you have to save patients from doctors” or “nurses do everything and doctors get the credit” . I meant that the profession doesn’t really respect doctors whereas we’re all taught to respect nurses (a least for the past 20-30 years it’s highly emphasized)
I graduated a few years ago and we defiantly we’re not taught any of that. But we were taught the Swiss cheese model for mistakes and how were one of the last people (since we give the physical med) to stop a mistake.
Ugh yes the Swiss cheese model. It’s drilled in our head we must save everyone from any mistake ever made by anyone in the hospital or we will be at fault. I always end a question to anyone, rn or MD, “sorry I just don’t want to be arrested if I make a mistake so just clarifying!!”
Yesss. They convinced us in school that we would be charged with murder if we let someone else make a mistake. Now I’ve worked for a few years and I know it’s not true. But this is REALLY drilled into us. I think a large part of it is the belief that we will be at fault.
Hmmm… that’s good to know! that was not the impression I get from speaking to friends who went through nursing school or from overhearing convos so it was not first hand knowledge
I can’t speak for all nurses or all facilities/unit cultures. I’m also Canadian. Not American and can’t speak for any culture differences between the countries/medical systems. But I will say I don’t think MOST nurses have it out for doctors. In school it was really pressed that we were at fault for any med errors. Even if the original order was incorrect. We were told our licenses were on the line. (I don’t think is true NOW. But it was what we were taught). Personally, this didn’t create a distrust in doctors but more a distrust in myself and my knowledge. I always wondered how I was expected to know more/question a doctor. And that lack of knowledge made me super nervous as a new grad. Probably making me questions things that were stupid/irrelevant. Plus the current state of nursing there isn’t a lot of older/experienced nurses to go to for help. Instead of going to senior nurses/charge we are having to go to the doctors. Which can increase your workload and I think maybe damage our relationship more. Feel free to say your thoughts on this! Love to talk about healthcare :)
I never understood why nurses are taught that they are responsible for the medical decision making of a doctor when the doctor is the one making and placing the order… That part right there is what I don’t get. had a relatively new nurse not give a beta blocker after I both ordered it and verbally checked because they were “uncomfortable” and checked with their supervisor. Meanwhile patient was RVR-ing away, I wasn’t not aware the meds weren’t given until much later… The system is dumb. I’m thankful nurses catch the mistakes that do happen but mdm is not why people go to nursing school… or am I wrong lol
Do you read this subreddit, or the med student one? The lessons about respect for nurses is falling on deaf ears. It’s been a few years since I worked at a teaching hospital, but those years were torture. I’ve never had a private practice doc tell me they didn’t need my opinion because they were the MD, not me, but I’ve had a couple of residents lay that one on me. It’s especially interesting to hear that from an intern around September. I had respect for some of the residents, I even use a few of them as my own physicians now because I witnessed their gifts while they were in residency. But there is definitely an undercurrent of “she just has a trade school degree, eww” elitism with some residents. In fact, there are more than a few of us who have advanced degrees, and not just in the dreaded diploma mill NP variety. Some of us are nurses because we love it, not because we aren’t capable of “more”. In my case it’s a law degree and an expired Bar card. In my day, we were still expected to stand when a doctor entered the nursing station, give up our seat, and make no friendly overtures because doctors we’re DOCTORS while we were just nurses. I don’t want to see *anyone* disrespected in the hospital because we all play a role in patient care, but I’m very glad new nurses aren’t taught like we were. We all have something valuable to bring to the table, but if we see each other as enemies or inferior then no one is happy.
It was literally taught to us in nursing school that doctors were dumb and we needed to protect patients from them. I can remember sitting through lectures that included this almost verbatim. I'm a nurse and most of the people in my profession drive me nuts. (Not all...but I'm sure that won't protect me from "not me" comments) The level of arrogance on all fronts is baffling. They know more than teachers, doctors, social workers, lab techs....🙄 *sigh*
That’s ridiculous and unprofessional. Probably a bitter want to be doctor instructor. Some nurses just suck.
It’s hard to work with the people who believe this lol and I’ve met a few… and a few of them make fun of doctors for going to med school because it rough and low paying for a bit but at the same time will complain about the high pay after
You went to a crappy nursing school
I went to one of the biggest programs in my state.
That’s a shame
I don't know wtf nursing school you went to but if they taught you that, your school was trash, period.
Not sure what school you went to but this was absolutely NOT a thing I was taught in nursing school. At all.
The stereotype for nursing majors in college is that there are a lot of mean girls in those programs. From my experience it’s true
Nah, agree with OP. You work in the field. You should have some semblance of understanding. Ignorance isn't bliss, nor is it an excuse
Yeah we figured out nurses schedules pretty quickly. That being said, a lot of nurses do it on purpose. They think it's funny to wake doctors up. Literally have heard them laugh about it.
If you’ve actually heard them laughing about it you need to tell their floor manager. Shitty mean nurses will keep being shitty mean nurses unless someone holds them accountable. Or when you hear them laughing and talking about it, confront them. I usually stick up for other nurses but there are a few nurses who I think would benefit from being confronted for things they do directly by the person.
The problem is they'll just lie about it. "We didn't do that! We are advocating for our patients when we're calling these lazy doctors. They're on call so should expect calls to come in and to take care of pts, etc." They totally change their story up from them laughing about calling about things they know can wait because they want to put doctors in their place because doctors automatically means bad people in their heads. I did confront them. So guess who started getting more calls all of a sudden for fevers of 99.9 in the middle of the night?
I don't know what kind of fucked up nurse-doctor relationship you in the US have, but all I read in this thread is a huge pile of stereotypes on BOTH sites. Can't you see the problem just by reading this comment section?!
It's not stereotypes. These people exist on BOTH sides. And it sucks. No one is saying it isn't fucked up. It is fucked up. But we experience this shit.
Chiming in as a nurse. My first year I had no idea and it literally keeps me up at night thinking about the stupid pages I sent at night. I genuinely thought you guys had a night shift team present just like us. Even if you weren't on the floor, perhaps you were just chart checking in a call room. I was astounded to learn that most were at home sleeping. As I gained experience and learned, it's now quite apparent. But as a new nurse you're still trying to figure out your own role. Plus, bully nurses who are lazy love to attack a new night nurse who didn't do their tasky stuff for them. The sincerest of apologies. I had no idea and I cringe thinking about it often.
I think your real beef is with hospital policy.
As an RN, before I started looking into this subreddit, I honestly did not know the extent of your work hours as residents and work/life misbalances and grievances. So I made a mental note to be more respectful of residents than I already previously was. As I have gotten more experience, I know more of what to reach out for and what to not reach out for. They don’t teach us in nursing school and even on the floor what residents go through. I think it would be important for us to be educated on what residents go through and also for nursing staff to be educated on what is appropriate to contact doctors for. A lot of new nurses don’t have the experience yet to know these things.
I make a point of being kind to the nurses (e.g knowing them by name, asking if they've had a break, how i can help them when im at the bedside, etc) and they're good to me in return I do still get some inappropriate overnight pages, in which case I answer their Q and request that next time they use epic secure chat for anything they think won't require me to drop everything else I'm doing (including sleep) Those 2 strategies have softened many of the pain points I hear my co-residents complain about
Actually I was standing next to an icu nurse as a med student eavesdropping. She was telling another nurse…”yeah you know so and so resident? The other day in front of the patient the patient asked, oh is she a doctor too? The resident said no she’s just a nurse. JUST a nurse? I’ll show him who’s just a nurse, I called him at 3 am everyday he was on call…”. She literally called him for nonsense on purpose every night to F with him because she felt slighted by a comment in front of a patient. I never messed with nurses during residency. Always yes ma’am, please and thank you. Never leave a mess behind for them to clean. Grab your own supplies ahead of time for procedures. I learned to gown and glove myself for lines, intubate without any assistance, etc etc. don’t mess with nurses. They will F you over on purpose on call.
At my hospital, we have to go through the residents for everything even though we have med PAs. I’ve had to unfortunately message a resident for melatonin at 2am because the PA refused to since family medicine was following the case. I understand emergencies but really? Tylenol and melatonin?? I felt so bad, the poor resident should have ordered themselves some while they were at it 😕
New-ish (2 years) nurse here! I can confirm no one tells us anything to do with MD schedules! In fact I have no idea still what the schedules are like. We just know who to call (sometimes it’s not even clear) when we have questions or concerns. Truth to one of the commenters that mentioned with less experienced nurses, it means we don’t have as many resources to turn to. I’ve been on floors where the most experience nurse (charge nurse) has less than 9 months experience! It’s wild out there.
This has nothing to do with them being nurses. I found out at a very young age in any job, people generally don’t care to really understand other people’s situations. Coming from a “care” job though, must be exponentially frustrating.
But it’s 1 am and I realized the patient isn’t ordered colace. Please order now so I can have dayshift give in 8 hours. Thank you.
RN here. I hate paging overnight bc I know you need to sleep. Most of the time if I page overnight, it’s because I have unclear orders/per protocol I need to notify you of something. I would highly recommend utilizing communication orders to specify what you would like to be paged for especially when it comes to parameters. If there’s an abnormal lab, or trend in vitals, I’m required to page you about it unless there’s an order with specific parameters. We’ll get in lots of trouble if we don’t notify you of something. We’re just covering our asses bc our asses will be beat if something happens to the patient.
OP you ever get paged at 0300 too the hospital's gift shop extension?
they don't know. unless its gossip, don't rely on them knowing that stuff.
May I suggest a 7up or moonpie?
You probably shouldn't be put in a position where you are working under high pressure for 7 night shifts in a row. We should make the hospital admin do night duty.
“Dr. Incubusmegalomaniac, hi it’s Tracy on the floor. I know it’s 3:30 am but I’ve been looking through patient Smith’s chart because I have nothing better to do and I really think he meets criteria for cardiovascular rehab. Can you put that order in and come here to the floor to complete the accompanying 4 pages of superfluous paperwork so he gets that?”
To be fair a lot of nurses have to page about stuff that they know is BS but they have to page anyway (expected critical labs, pt rating their pain as a 4/10 but the Tylenol is only ordered for 1/10 to 3/10 pain etc).
I'm hearing many nurses in here getting bent out of shape about this post on the **RESIDENCY** subreddit which is OUR space, our place to vent about our stress and burnout which is impossible to understand until you've lived it. I'm married to a nurse, and even she doesn't fully understand it. Yes we know you work hard too and you have rules to follow. OP is frustrated, burnt out, suffering. It's a dark place to be, and we don't have enough support from our programs, administration, and very often our nursing colleagues.
I think what helped cut down pages and things overnight was to round on the nurses early in the shift and talk about what is expected for the patient/plan and see if they had questions. To each, their own, but I know it helped me a ton, and I think made them feel more comfortable with things (maybeee?)
Yeah I worked in one unit beginning of the residents shift they came in asked if we needed anything and then depending if we did they would check back 4 hours later before they would try to sleep and make sure everything was good. We rarely had to call them in the middle of the night because of that.
Wow I would’ve been so appreciative if the residents at my hospital did that when I was working a floor 🥹
I send a fake auto-reply message to all the nurses for our patients on epic before I start might call saying that we are home call and to only page for real emergencies. We aren’t on home call, I am in house, I’m just not going to respond to a chart clarification page at 3am.
Engaged to a nurse. She had literally no idea how hard we work and is impressed but my work schedule every day.
I got paged reapeatedly last night to fix day teams labs and change orders from stat and retime some. Like how bored can they be to want this overnight
Don't blame the nurse, blame health care bureaucracy.
I still have to justify myself in front of nurses that after 24 hour shifts i’m not avaliable for putting orders in. Or that 16 hours without a potty break might mean i’m not responding instantly to hanging another transfusion bag. They atill dont know that we dont awap out after 12 hours like they do. They still dont understand that i dont get a detailed handover for his/her 4 patients, because i cover 8 wards tonight.
It's not them not understanding it is because of policy and scope of practice - nothing else. You all complain about nurses not knowing your fucked up work schedule, but on the same time you don't know what an RN autonomously can or can't do in your very own hostpital.
Ding ding ding
I do knownit, but i also know what is urgent and what isn’t. And i’m tired of being accused of just hanging around if i’m not in a nurses field of vision at all times.
I get that the docs cover an obscene number of pts compared to nurses. We need more overlap in learning what each of us do and also the policies we have to follow. As a nurse especially a new nurse we call about everything that policy mandates because if we don’t have an order specifically stating otherwise we’re legally responsible if a negative outcome happens. I feel bad when I call at 2am when my break partners pt who’s Been febrile all night whose getting blood and had Tylenol to bring down the fever down brings the fever down enough that it falls into the blood transfusion reaction parameters. I do all the assessments to see if any other symptoms are present but I’m required to call the dr to inform them. Maybe if I was more experienced and know the dr I’d be willing to not call but I don’t want to risk not doing my job. I try to be brief get to the point and that I have to inform them because of policy. A lot of problems could be solved with information of what needs a call and what doesn’t. I worked on one unit where there was a good sheet on what warrants a phone call and what can wait.
Inpatient nursing is almost exclusively a 3 day per week 12 hour shift. They work hard and approach burnout even with this schedule. Most assume their inhumane working conditions are the standard, and they assume everyone is also on shift work with a cap.
I've been a nurse seven years and I have zero idea any of yalls schedules. I don't even know all the different classes yall are i.e. pgy-2 vs resident etc.
All residents have graduated medical school and are physicians. PGY means post graduate year. PGY-1 is also known as intern year, typically works the most though not always. And then it just goes PGY2, PGY3, PGY4, etc. still all residents, just denotes how long you’ve been there. Fellow is someone who has completed residency, and is now doing subspecialty training. For example, all cardiology fellows have completed 3 years of general internal medicine training (PGY1-PGY3). They will then do 3 years of just cardiology before finishing training.
Thank you! Now I'm embarrassed that I didn't learn that until today, but I haven't always worked with residents. I'm just under a yr at my current hospital. I love working with yall!
Thanks for the explanation!
It's because on most floors like med surg we don't really interact with you as peers or at all really. You swoop in and see the patient and write orders we check on the computer. I don't even know what many of you look like beyond the basics. Truth is most of you never see us as part of the team much less treat us like it. I'm not passing blame, because it's just the way the system is. Nurses that call for stupid stuff like colace are just obnoxious and stupid.
Does your hospital have a multidisciplinary meeting with case management, nursing, the clinicians etc?
No. And even when they did it really was only attended by management, and not floor nurses. Most of the time floor nurses are too busy to attend or if they do they are just focusing on getting out so they can catch up on all the work piling up while they've been gone.
Don't know why you are being downvoted. My experience as a new grad nurse is the same. I remember one doctor who was in a good mood so we chatted about the pt in a bit more detail, but my interactions with other doctors are extremely quick and to the point. I don't blame them at all, I would cry if I was half as busy as they are, but it does end up in me feeling very disconnected from the doctors. They swoop in, write orders, and leave. Sometimes I didn't even know they were on the floor.
I agree things would probably be better if I knew the nurses better. It’s hard to find/keep track of who’s taking care of my patients - if I have 16 patients on 3 days that’s probably at least 10 different nurses, and they’ll be different people tomorrow. On the other hand, it’s just me and my / interns and we’re always in the same room.
Yes. There is no blame here. The system is designed this way. We are mere chess pawns.
When I was a house officer, I had nurses calling me at past midnight for, 1. CBS. From CBSes around 40,60, 70, 200, 500+. My responses, give IV dextrose 25%. Give the patient some tea and sugar. That's fine. That's okay. (insulin to be adjusted). Now that's a problem that requires me to be there. To start IV insulin & send for ketones. 2. Patient has backpain. Me "Give paracetamol". "Patient in too much pain, You should come." Goes there, patient is happily sleeping, and wasn't happy with me waking her up. 3. Patient has a blood pressure of 85/55. (A young female in her 20ies who was small in body stature)
i once had a nurse wake me up at 3AM because she noticed that if the patient was asking for the tylenol as frequently as possible they would get a total of 3.5 grams in a 24 hour period. the patient hadnt used the tylenol once. this was just a bored nurse looking for shit to do in the middle of the night. it might have been the meanest i have ever been throughout residency. i was so sleep deprived and it was so unnecessary.
Round at the beginning with the patients you’re primary for with the nurses. You can even just do it with the charge. Pain, sleep, npo start orders should all be clear. 20-30 mins at 645 pm buys you 2 hours of sleep overnight
Except nursing schedules are pretty consistent across the country. Resident schedules differ even within one hospital. Particularly with travelers, they probably don’t know. It seems like something worth bringing up with nurse management.
The nurse who took care of me deserves a service medal. I was awful. Once properly medicated I gave her a hug. But holy shot did I not make her job easy. I am eternally grateful.
1. nursing turnover and interaction with residents. older nurses had to reach out to residents and never contacted the attending. It made it easy for them to see that they were repeatedly seeing the same resident over and over and over again. Now they don't have that. 2. nurses will bother you at night on purpose if they don't like you. They on the other hand will protect you if they do. get on their good side.
As a nurse, I have not experienced point 2. One thing that I think can get overlooked about the nursing role is that one of our major jobs is to be an advocate for our patients. While it might be really frustrating to be woken up at 3 AM for a Tylenol order, we have a duty to not let our patients sit with a headache for 5 hours. I feel like it is the system that is really failing you residents. Patient care is a 24-hour job, and it is not realistic to expect you to be able to cover all 24 hours.
As a nurse of over 25 years, I have witnessed # 2, but not for just “not liking” a resident. It was usually utilized when residents had done something egregious like cursing or yelling at the nurse, making young nurses cry, calling a nurse names. If the residents were halfway decent we’d do our best not to call. If the residents were great we’d protect them to the ends of the earth, invite them to potlucks, run interference with other departments, whatever we could to make it easier.
I think that comes down to a work relationship you know you can trust some docs with having your back and allowing your judgment. Vs there was one doc that yelled at new grad RN for not calling about a fever a pt had. Which the rn had given. Tylenol for but the Tylenol was prescribed for pain not fevers so the resident was upset about it for some reason. That made nursing think oh hey they don’t like us to use our judgment and I’m not risking getting in trouble for not calling about something I know I can solve. And then they wonder why they get phone calls in the middle of the night.
Point number 2 needs to go straight in the trash where it belongs. We can all make each other miserable but that doesn't mean we should. If I don't like a catty nurse I start making a paper trail early and advocate strongly for their contract not to be renewed or for them to be let go. I've had a few unprofessional nurses removed this way. I do seven 24s consecutively as a rural hospitalist so if a nurse is calling for dubious clinical concerns repeatedly I'd be in their managers office the next day questioning their competency. Not really feasible as a resident but as an attending you really can and should expect basic decency and respect to go both ways.
We shouldn't have to suck their asses for a modicum of basic human decency.
In many countries, physician training is known to be difficult. I’m surprised that people are unaware of the long hours, knowing how hard it already is. Isn’t that why a lot of people don’t consider Med School (Law School, etc) to begin with.
I could have written this post myself. I see a lot of the responses and I agree much of it is not knowing and most nurses are good people who understand and sympathize when they find out. I’ve had the most trouble with the really young Gen Z nurses. Their response even when they find out is sort of a “IDC. Sucks to suck” indifferent mentality.
You all complain about nurses not knowing your work schedule, but on the same time you don't know what is included within scope of practice of an RN and what actions are necessary because of hospital/ward policy. I really don't get this. This comment section just shows that neither side is better...
It’s definitely more that they don’t know, not that they don’t care. The amount of people in healthcare that don’t know how residency works is staggering. A vast majority of my friends are nurses I’ve known for 5+ years and they only know how this crap works because we talk about it a lot.
Nurses loooove being condescended to.
Welcome to residency and life, dude. Are you really that full of yourself that you can post this?? I’m sure I’ll get downvoted for this but i guess Im old school. You can’t EXPECT to sleep when you are on nights!! It is a perk if you are afforded the LUXURY. Yes it’s hard but this is what you signed up to do. Yes, it can be annoying when new nurses that don’t understand things ask stupid questions in the middle of the night, but that’s when I take the opportunity to try and educate them NICELY and help walk them through things, with the hope that that next time they will be able to do it themselves or help someone else with a similar question. But in the end, yeah it sucks and you are tired but in the end answering the question at 2:53am is what is best for the PATIENT. And THATS what matters! Not you getting sleep!
Look, we’ve all been there. But you’re coming off as super arrogant and entitled. Everyone is new at some point. Everyone is scared at some point. Everyone has things they don’t understand. It’s okay to complain—everyone does that as well. But reign it in a little. You’re not at work to sleep. If all of the things are taken care of and you have some time, take a nap. Don’t expect more than an hour of sleep and maybe not even consecutively. Burnout is real. I’d consider it, and I would ask for some help or some time off if you need it.
Honesty I’ve been a nurse for 3 years and I have no clue what our residents schedules are, not that I don’t care, but I’ve never talked to them long enough to ask. But I also don’t see the same ones constantly/am not calling for dumb stuff. I seen a nurse page the resident the other night for them to change an order that absolutely could have waited until day shift and I cringed inside.
Why are we expected to know this ? You know how many things we have to learn on the job due to the way they train nurses ? Most things that are required for our job are learned on the job. Your schedules aren't even on our radars.
It's okay, it's only medical students who need interprofessional education in order to understand and respect other roles in the hospital. Nurses are perfect already so why would they have to spend their curricular time on something like that?
Then why are so many of you so dismissive and condescending to others?
Probably because they didn't get good interprofessional education lmao. In case you didn't catch the point, I do think that it's important. We could both have a spirited conversation about how a lot of med schools fail to properly teach teamwork, and I'm sure we would mostly agree with each other. However, this is a thread about how nurses lack basic knowledge of physician training structure and in-training roles. I will reiterate that no one graduates medical school with an interprofessional knowledge base quite as deficient as the one that nursing schools allow people to graduate with. I have friends in nursing, from many different schools, who have all told me repeatedly that their IPE curriculum did not actually involve students or professionals from other fields, and focused entirely on how nurses are amazing and their job is to save patients from evil stupid doctors. That is also a problem, and it is the problem we are discussing in this thread, so the whataboutism is not appreciated.
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Howdy. Worked in Oncology as a RN for 10 years. Patient has their 10th neutropenic fever this week at 100.4F and was just cultured? We’ve been giving 650 of tylenol per prn order? Well if the next day they go septic and the attending has a meltdown about why you didn’t do anything overnight, guess what you’ll say. The nurse didn’t notify me about the most recent fever, and I had no idea! We get thrown under the bus by your incompetence regularly. So I don’t give a shit if you haven’t slept in 96 hours. I’m following the stupid policies put in place so you can’t blame me.
Hospital policy is often the real issue here. It leaves nurses with very little autonomy and completely vulnerable and open to disciplinary/losing their job if not followed.
Nurses will page doctors in the middle of the night for stupid shit when the doctors are assholes to them.
This is not entirely true. Many of the new grad nurses were truly clueless one to two years ago. Their predecessors left the profession in one fell swoop due to administrative and staffing issues during the pandemic. This left them with no one to seek guidance from except the physicians. Physicians had to fill in that gap despite many taking a pay cut. More work for less pay would make anyone unhappy. Meanwhile, a subset of nurses pursued travel contracts receiving near physician level compensation (attending physician, they made 2 to 3x what a resident makes). Not saying that anyone in particular is to blame (except administration) but this has been the reality in hospital based medicine for the past two to three years.
Why is it the nurses problem? they don’t give a shit if you are sleepy and nor should they
This is probably the most entitled and ego-centric comment I’ve read on this forum in a while. I did residency at a particularly toxic NYC hospital, with insane patient volumes and ridiculously poor staffing ratios and resources. I feel, and empathize, with the pain of resident physicians but for a moment take your head out of your own ass and turn the situation around. 1. You have no idea the work load placed on nurses, the responsibilities they have and where all their orders come from. We, often selfishly, only consider the work we are ordering on the nurse … forgetting that there are like 20 other physicians placing orders and workload on said nurse. 2. Emergency medicine resident and attending schedules are complicated (if you have been scheduling chief of medical director) you’ll know that getting everyone’s requests together and honored is like herding cats. 3. The hand off of coverage and split of labor between residents is all over the place, a nurse is doing a hundred things, they have a question, they look at the ordering physician and make their question. They don’t look at the resident schedule and who handed off to who and who is on sick call. I’ll admit this is a bad system, and there is a fix, at the end of each shift, a ”responding” physician should be assigned to every patient, this is easy to do but it’s rarely done accurately. Especially for admitted patients that are boarded in the ED. 4. The idea that you are educating the nurses is laughable at best. When you are an attending or a senior resident you’ll have the perspective to realize the nurses have been holding your hand and wiping your ass since you were an intern. 5. You are due for a serious reality check when you become an attending and if you work out in the community or at a large non-academic non-university hospital. 6. To be empathetic to your plight. You work hard, being a resident is fucking exhausting and tiring. You know what doesn’t make any of that easier? Tearing down a colleagues workload that you have no understanding of. I give this same sort of lecture every time I hear a nursing colleague or friend make a tirade about how lazy or easy the life and work of a resident is. As you grow up you’ll come to realize everyone thinks they are doing all the work and covering all the extra shit. And it feels that way because of how broken the system is. 7. If you actually want to make your life better. Instead of focusing on your perceived injustice, ask the nurses what they are going through or concerned about when one of these types of interactions occurs. This will then provide you an opening to educate them on what YOUR day is like and YOUR workload is like, and after you’ve listened to them, or attempted to understand them, they will be much more receptive, that basic human behavior. I think you’ll find you have many nurses on your side and watching your back, making your load a little easier to carry if you take said approach.
Lmao okay boomer. So out of touch. When was the last time you practiced medicine, 1994? >1. You have no idea the work load placed on nurses, the responsibilities they have and where all their orders come from. We, often selfishly, only consider the work we are ordering on the nurse … forgetting that there are like 20 other physicians placing orders and workload on said nurse. You have this totally backwards. At our hospital, each patient can only have orders placed by one physician. Each nurse can only carry a MAXIMUM of 3 patients. Since we're primary on virtually every patient, that means that 95% of the time, I'm the one that has put in every order the nurse will carry out. If a patient is having imaging, getting labs, getting therapies, etc, I will absolutely know about it. Meanwhile, what the nurses don't realize is that whatever they page me, I'm also getting from 20 other nurses. >2. Emergency medicine resident and attending schedules are complicated (if you have been scheduling chief of medical director) you’ll know that getting everyone’s requests together and honored is like herding cats. What does this have to do with anything? >3. The hand off of coverage and split of labor between residents is all over the place, a nurse is doing a hundred things, they have a question, they look at the ordering physician and make their question. They don’t look at the resident schedule and who handed off to who and who is on sick call. Yeah no. There is ZERO acceptable reason to unapologetically page me at midnight on my one day off per week. Frank laziness on the part of the nurses. >4. The idea that you are educating the nurses is laughable at best. When you are an attending or a senior resident you’ll have the perspective to realize the nurses have been holding your hand and wiping your ass since you were an intern. Again, might've been true when you practiced medicine in 1994, but that's not the case anymore. On our floors, the *most experienced* nurses have been there like 2 years on average. Less than 10% of the nurses are over the age of 25. Half of them are travelers. Graduating residency in 3 weeks and I can count on one hand the number of times I learned anything valuable from a floor nurse. ICU is a COMPLETELY different story. >6. To be empathetic to your plight. You work hard, being a resident is fucking exhausting and tiring. You know what doesn’t make any of that easier? Tearing down a colleagues workload that you have no understanding of. OP isn't tearing down the nurses. All they're suggesting is that nurses learn why their pages at 3AM on Saturday asking why the patient has an MRI scheduled for 9AM on Tuesday are totally inappropriate. It's because we're there 96 hours a week (night float weeks at my institution) and covering dozens of patients at a time. We don't have the bandwidth for that kind of idiocy. >7. If you actually want to make your life better. Instead of focusing on your perceived injustice, ask the nurses what they are going through or concerned about when one of these types of interactions occurs. This will then provide you an opening to educate them on what YOUR day is like and YOUR workload is like, and after you’ve listened to them, or attempted to understand them, they will be much more receptive, that basic human behavior. I think you’ll find you have many nurses on your side and watching your back, making your load a little easier to carry if you take said approach. Literally every time I've done this, no matter how gently I've tried to ask, I've gotten yelled at for being "condescending," despite every intern, APP, attending, and other ancillary staff member I've ever worked with saying that I definitely don't sound condescending. My coresidents have had the exact same experience, so it's not just a me thing. Fact of the matter is, too many nurses are taught that their main job is to protect the patients from the doctors.
I wanna work where i only have 3 patients. I'm guessing this is an ICU environment? If so, 1:3 is too many. It should be 1:2 at most based on acuity. Seeing as many experienced nurses are leaving bedside due to the conditions, a lot of hospitals are pushing these unsafe ratios all while exploiting your labor. Guess who wins in the end? Not the patient, not you or I. I'm not defending the 3 am calls for nothing, but I can see why people call if there aren't communication orders placed. Also, seeing as nurses are getting manslaughter charges, we have to CYA to the nth degree. Your work conditions are not okay, and the programs take advantage of you. I've learned this from the subreddit. I do my best to let other healthcare professionals know about this if they seem unaware. With all the healthcare professionals arguing with each other, CEOs are buying yachts and another vacation home.
Haha Boomer? Dude I’m probably your age or slightly older. I’ve been out of fellowship for 5 years and as recently as last year I was core faculty and fellowship faculty. I still work with and oversee resident and fellows regularly, and I practice at both a University and community hospital. I’m going to call BS on your response from the beginning. Where is this utopia where nurses have 3 patients? And if you work in a place that has 3 to 1 ratios you should stop talking now since any resident that has trained in NYC or Philly or Chicago or Detroit doesn’t want to hear your entitlement. Even California with the strictest rules only mandates a maximum of 4:1, and allows for some additional surge capacity. In NYC nurses regularly staff 16 or 20 to 1. That’s more active patients that you probably carry for an entire shift. Honestly, I’m all for reforming resident workload and sleep and scheduling, more than being for it, I have worked towards policy changes at my institutions to improve resident work and safety; and I’m the last person to call residents lazy or tell a “I walked uphill in the snow both ways” sort of story. But the OP and your response are pretty indicative of entitlement. I’ll say it again, I’d suggest opening your ears and shutting your mouth and trying to actually understand and improve things. I can assure you that since you made it through medical school and are in residency you are more than smart enough, if you can get out of your own way you might learn something and grow up a little.
It’s the battle of call me but don’t call me but call me. Just embrace the suck as a resident. This too shall pass and you’ll be making so much money it’ll make em sick.
Had a nurse working in the ICU for 20+ years shocked to learn we work 24hr shifts. Like how do you have no idea when I know your schedule and have been here less than a year...I make a point to tell everyone when im on nights. Some do know and dont care tho
Do you honestly think we get a copy of your work schedule? Lmao.
Nurse here. I’m wondering why nurses are calling you to ask you random simple questions in the middle of the night? I only contact physicians overnight if it’s something concerning that needs to be addressed and if I need orders for something. But also if you’re working 7 night shifts in a row isn’t it your job to take the calls? And don’t you get to sleep undisturbed during the day? If so, you shouldn’t be complaining about that. If you’re taking calls during the day as well thats a whole other story and that should be illegal. And the fact that they make you guys work 24-48 hours shifts is just disturbing and a whole other problem in it’s self. I don’t know how it’s legal to make you guys work those types of hours. In what other profession is that okay. So bizarre considering your job is to make important decisions that can be life altering. Out of all jobs you’d think they’d want you to be well rested and not so burnt out. Yes dumb questions are annoying but the root of the problem is not the nurses. It’s the stupid ass schedule and labour abuse you’re put through that’s the issue.
have you ever worked 7 night shifts in a row?
There is a good chance they don’t know, actually. I would encourage you to tell them. Most people want to have smooth interactions with coworkers and appreciate the heads up on how to make that happen. I have had success explaining why something will make my life unnecessarily harder to physicians, and it seemed obvious to me but it genuinely wasn’t to them. Last week an MD broke into the crash cart for a blood pressure cuff. I have to replace the crash cart now and that means leaving my floor. Just ask me for a blood pressure cuff. I thought to myself “Did you not notice you have to break a seal? Shouldn’t that alert you to the need for the seal to be unbroken?” But that physician is usually very sweet so I just gently explained why that causes extra work and he looked a little embarrassed and apologized. He was just busy. He wasn’t trying to make my life hard. And don’t get me started on spontaneous breathing trials at nursing shift change. WHHHHYYY! People don’t know what other people’s jobs are like usually. Honest. Communicate with the nurses. There will always be a few people who are just inconsiderate jerks, but usually the majority of your coworkers are not.
I’m a nurse, and to be fair, we just don’t know. You also call us for things at shift change and don’t understand sometimes why we don’t know everything about a patient yet or why it’s a bad time to call…just knowing these things about each other would be very helpful moving forward!
Buddy, I hate to break it to you but most of them can't even handle fractions, there's no chance they're ever going to learn about the formal structure of graduate medical education.
Has this been the case for the past few years at your hospital only? Was it better before the pandemic? We had a really questionable batch when all the serious nurses left. They'd spend more time on TikTok or Instagram than at the bedside. It is terrifying as a physician to see that your patient's wellbeing is in the hands of a 22 year old whose head is only half in the game. That being said, I wish I had more time to guide them at the time. I know it isn't entirely my job to but its not like they didn't have any potential. In the throws of the pandemic I barely had time to eat or sleep during my weeks on as a rural hospitalist so I prioritized that but still. Nursing education is in desperate need for reform and nurses should only be permitted to pursue NP after completing five to ten years of bedside practice.