Sanity is madness put to good use. – George Santayana
I wrote this post a long time ago when I first started blogging. I’m recycling the post because this information bears repeating. I’ve been seeing some behavior lately that is inappropriate, and I’m telling you this stuff for your own good. Please, never roll your eyes at a nurse who is old enough to be your mother. She may be going through menopause, and it could be the last thing that you ever do. Just sayin.’ Don’t make waves at the nurses station.
I worked as a neurosurgical nurse many years ago at a teaching hospital in the Midwest, and twice a year a new crop of interns descended upon our unit. It was the best show in town. The spectacle began with the chief of neurosurgery, Dr. Holier Than Thou, strutting on to the unit with his entourage marching behind him. He stood before the crowd in his impeccable white lab coat, telling everyone within earshot of his importance, and how he held the power of life and death in his hands. I would sit at the nurses station and snicker at the biannual parade, and remembered my first day in the hospital as a nursing student. Two interns had asked me to go into a patient’s room to get a set vitals signs. They didn’t tell me that the patient was cold, stone dead. I walked into the patient’s room, saw the dearly departed, and calmly walked back to the nurses station to find the interns laughing their fannies off. I told them they were going to make damn good doctors one day, but first they had to learn what rigor mortis looked like. Nonetheless, because every new group of interns looked like lambs being lead to slaughter, I pitied them, and I gave them information to use as a survival guide. These are the rules I taught them about working with nurses.

1) Nurses deserve respect. We are with the patients twenty-four hours a day, seven days a week, while doctors are only able to see patients a few minutes a day. Smart interns forge alliances with the nursing staff, and understand that nurses can save their butts when something goes wrong with one of their patients.
2) Don’t take the last piece of pizza in the nurses lounge unless you are invited to do so. Nurses are territorial about food.
3) Nurses do not tolerate interns with a budding God complex. Nurses have no problem calling arrogant interns every hour on the hour for Tylenol orders, especially at night. Arrogance breeds contempt.
4) Don’t be stupid. If you want to complain about nursing care, be careful when you approach a nurse who is working the last half of a double shift. Refer to rule #3.
5) Nurses are your friends. We want to see you succeed, and if we like you, we will make sure that Dr. Holier Than Thou doesn’t find out that you order Demerol 1000 mg, instead of 100 mg, IM q 4 hours PRN because you were dead on your feet after being on call for three days in a row.
mojo
May 28th, 2009 at 12:12 pm
When will they learn?
My favorite is when I call them an A***hole to their face for the first time and their jaw drops. Then I tell them I’m going to call the attending and tell them how much of an A****hole they are acting up. Talk about waves of fear, sweat and terror in their eyes until you tell them NEVER, EVER do that again!
And as someone rapidly approaching the M-word, oh baby! Don’t even get near my toes, much less step on them!
VetRN
May 28th, 2009 at 9:35 pm
I gave my own son pretty much the same advice when he was an intern. At first I got kind of a “WTF—I’m a doctor and you’re a nurse” look at the time (he’d never have dared say it aloud to my face or I’d have slapped the taste out of his mouth). But during his residency, which will be finished in 33(count ‘em!!!!)days, (can you say “gainfully employed”?) he admitted that he had found a couple nurses that he trusted and respected, had asked for advice and help from them, and that they had indeed, saved his ass on more than one occasion. In fact, during one particularly hellish holiday weekend on call when none of those nurses was working, he even called ME (also working in an ER 70 miles away on that same hellish holiday weekend) to pick my brain. Amazing isn’t it, how a “stupid” parent (and nurse) can develop intelligence overnight?
Chad Estes
May 29th, 2009 at 7:32 am
Love it. Many pearls of wisdom there. Nurses do deserve respect, and for some reason, it’s not at the level it should be. In the words of Cartman on SouthPark, “RESPECT MY AUTHORITA”.
Keep up the great writing.
Tina RN
May 29th, 2009 at 12:29 pm
Your posts are great. I would like to link my new blog to your site. I know my readers would love your take on nursing situations!
Liz
May 30th, 2009 at 12:16 am
You’re right, we do want to see residents succeed. I worked with many residents who were caring and capable. I also remember a few who I really hope went into pathology.
I was always fond of having to obtain the colace order at 1 am.
It’s really important to remember that patients are in the hospital to receive nursing care, performed by nurses, not doctors. It just happens to be convenient for MD’s to follow their patients all in one place. It’s also convenient to be able to have surgery and nursing care all in one place.
Most nurses want to be nurses, not doctors. We enjoy patient care and being at the bedside. Doctors are indispensible but so are nurses.
One Nurse
May 31st, 2009 at 1:04 am
Love this post! It can’t be said enough. . . at least not until all the interns start to act a little. . ok ALOT differently!
They eventually learn we are on the same team and we can help them and work together, but not until the “new” wears off and they fall on their face a time or two.
Definately worth posting and reposting!!
tammy Swofford
May 31st, 2009 at 11:18 am
Loved the post! It brought back memories of my time at a teaching hospital in Fort Worth.
I remember running a code with an intern who was busily telling me to give 15 mg. of Lidocaine for V-fib. Thank God, I just gave what I wanted and ignored him. ha I think he was imagining hanging a gtt. smile
We all have to learn, we should all remain humble in the process and also humble as we then mentor others. I do agree with the observation of not taking the last piece of pizza in the box. We will kill for much less on a busy day in our PACU when we have ordered a pizza after 12 hours without a break. wink
Tammy
AnnieH
May 31st, 2009 at 12:46 pm
A chorus of AMENS, sister. Somehow interns come out of their classrooms believing they’re the only ones who affect patient care. The silly minxes. Perhaps it’s from watching too much “House”. I see the disregard more frequently as I get older/and the interns younger. Don’t know if it’s generational or the folly of youth. As an older RN with 30 years under my belt at Big Fat Teaching Hospital it’s much easier to state,”I know you’re not talking to me like that. Try again” than when I was a youngster and had not raised my own motley crew. Although, tasers would help fabulously some days…
The Happy Hospitalist
June 1st, 2009 at 5:31 pm
Don’t forget the last rule. Doctors save lives. Nurses save doctors and lives.
Of Interest on the Web – June 2, 2009 « Off the Charts
June 2nd, 2009 at 11:50 am
[...] for those of you in the mood, here’s one nurse’s blunt message to new interns. A brief excerpt: I worked as a neurosurgical nurse many years ago at a teaching [...]
Straussrn
June 2nd, 2009 at 3:11 pm
Let me tell ya,….I’ve been a prison nurse for 7 years. I’ve gotten more respect from murders and rapists than I have from interns & residents……go figure!
Jennifer
dragonfly
June 3rd, 2009 at 8:42 am
As someone who will be an intern in 6 months, I completely fail to see how rudely wasting the time of another health care professional (with disrespect to the diseased at the same time) is funny. I hope that isn’t something I learn.
RookieDoc
June 4th, 2009 at 7:58 am
Great post.
For many, the appearance of arrogance actually comes from an intense fear of failure and fear of being exposed as someone who somehow slipped through the medical education cracks.
Unfortunately, some people try to cover or hide the fear, rather than saying, “You know what? I’m nervous. This is new to me. What has been your experience?”
“Smart interns forge alliances with the nursing staff” – great quote. If interns and nurses don’t see their missions as the same, they’re missing the boat. There’s a difference between a mission and a role. Both play different roles in the same mission.
And yes, there are too many new docs who start internship with an air of arrogance and, at times, downright rudeness. But, there is also a large pool of nurses that start off assuming there’s a turf battle. And both of these continue the cycle.
This probably sounds a little fluffy, but it would all be a lot smoother if we assumed the best in others.
For interns:
– Don’t assume you have to know everything.
– Don’t be afraid to ask for help
– Nurses know their job better than your attendings
– Social workers know their job better than your attendings
– The more you understand others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.
For nurses:
– Interns are nervous, & everyone expresses it differently
– Be patient with the new folks
– Be especially patient with new interns from other cultures
– Don’t start off assuming a turf battle… sure defend that last piece of pizza
– The more you understand about others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.
Anyway, love the post… I’ll be sharing it on my blog
http://RookieDoctor.net
Ed
10 + 1 PubMed Tips for Residents (and their Instructors) « Laika’s MedLibLog
June 30th, 2009 at 8:18 am
[...] I’m sure doctors will give plenty advice on the skills that are most important (i.e., see here). But what advice can I give them? I’m not a doctor. I could give them some examples of “how not to behave”, but I’m sure that will be covered well by fellow patients, and probably also by blogging nurses (i.e. see the perfect Intern Survival Guide by Mother Jones RN). [...]