Why, specifically with nursing, do the most unprofessional, disorganized, dysfunctional, mildly retarded, socially inept @$$holes unfailingly become middle management? Is this Affirmative Action for jackasses, or are they hiring the handicapped because they're fun to watch, or is it just that senior management can't, in my father's memorable turn of phrase, actually and reliably "tell $#!^ from Shine-ola"? I confess to feeling uncharacteristically baffled.
Do an experiment: think of the co-workers you'd least like to work with, and the ones you'd be most inclined to fire for their shenanigans if you were King or Queen For A Day, (or for students, the ones you consider deadweight on clinical and lunchmeat during lectures), and for any position you stay in more than 5 years, keep track of how many of them become charge nurses, nurse managers, and clinical coordinators.
If you find someone who's so gratingly annoying the whole department wants to smother them with a pillow, congratulations, you've just met your future supervisor. If they want to fill the pillowcase full of IV pumps and beat them with it, you may have identified a future CNO.
I bring this up because, surprising me not a whit, yet another terminal management failure has been inflicted upon my work unit. She's a legend in her own mind, and clearly, at some point, she was allegedly a decent nurse.The problem comes in that when handed any slight amount of authority, she defaults to Genghis Khan-like management techniques, that probably didn't even work for Genghis, back in the day.
Which leads not only experienced me, but utter newbies on the staff to recognize in 0.02 seconds, that she's scared spitless because she's too insecure to shut her piehole and work with people, actually listening to them and MANAGING them, because she clearly lacks the wisdom, experience, competence, self-confidence, or basic 3rd-grade-level human coping skills to not dictatorially try to micromanage everyone like they were Barbie dolls at her tea party 24/7/365.
That style didn't even cut it in the Marine Corps among fresh recruits with room temp IQs, so it sure as hell isn't going to cut it with trained degreed professionals and experienced support staff.
I mention it because it's a wee bit off-putting.
And a corollary, which I'm sure shows up somewhere on a managerial training curriculum is that when you hire and promote the least competent people, it not only destroys morale and lowers productivity, it also demonstrates to everyone down to the janitorial level that you have your own head so far up your @$$ that you can't tell the difference between someone who's good and someone who sucks, and that you're - theoretically, at least - the very supergeniuses who sign the checks and direct the affairs of the entire facility. Which scares the hell out of we, the employed.
So somewhere in the Rules For Big Wheels, there has to be written the caveats:
1) Don't pull your pants down in front of the entire staff every day by hiring management morons
2) Try and demonstrate some basic level of bare competence unless you like the sound of laughter behind your back pretty much in perpetuity.
At this point, I've seen upwards of a dozen various management folks come through, and go out the other door. I could count the keepers on my thumbs. (And one of those two handed the promotion back to them after a year to go back to bedside care, because it was corroding his mind and destroying his soul, not to mention starting to hurt his marriage because of how it was affecting him.)
And as these personnel decisions are invariably made by the same people who make clinical decisions for the hospital, one is left to wonder how, other than bare good fortune, we don't kill people like the Black Plague going through Europe in the Middle Ages.
Friday, September 20, 2013
Wednesday, September 18, 2013
Diagnosis Of The Week
Thanks for stopping by, and helpfully signing in with everyone's favorite chief complaint:
tummy ache.
Sometimes, you helpfully narrow it down to a flank or a quadrant, and other times, not so much.
Which is why it's called Mystery Abdominal Pain.
Which occasions the triage nurse getting out their deerstalker cap and meerschaum, and playing Sherlock Holmes with you, crossed with a really thorough police interrogation. (Tip to family members: shaddup, and let us get the answers the patient has. We'll be happy to let you fill things in afterwards, but first things first, 'kay?)
For the anatomically vague, a brief lesson.
Chest pain is rather straightforward, there being far less "stuff" to deal with: heart, two lungs, ribs and muscles. Yes, there are other things there for more detail-oriented folks, but that's the highlights. And even then, >5 out of 10 patients with chest pain go home with a diagnosis of "atypical chest pain", which means it's probably not a heart attack, pulmonary embolism, broken ribs, aortic aneurysm, tumor, or 27 other things, and we don't know what it is, but we're relatively certain it isn't going to kill you - tonight, anyway.
Abdomens are a bit more problematic. You have a diaphragm, esophagus, stomach, liver, gall bladder, two kidneys, pancreas, spleen, two different intestines, an appendix hanging out down in the corner, and for those with the internal plumbing option, a full set of female tackle for gestating and producing offspring.
Things that'll kill you relatively soon are things like appendicitis and an ectopic pregnancy. Everything else may only make you wish you were dead. We'll be focusing on the life-threatening options first, and trying to narrow things down as we move along.
Either way, to find out, we're going to need to do a few things. Things like blood tests for standard labs, a CT and/or ultrasound, and we need your pee to make sure you aren't pregnant. For the record, the more sure you are that you "couldn't possibly be" so, without a picture of your uterus in a jar, for any female between about 5 and 50, generally just convinces us you're lying at worst, and mistaken at best, so work with us, and just give up the pee, 'kay?
This is where you can shine, and help yourself: see that computer you're reading this on? When you finish, go to your word processor, and type in your allergies, medical history (that means the things someone with "M.D." after their name has actually clinically told you you have, not the things you Googled before you came in or think you have), along with any surgeries, and a pretty good breakdown on your problem as you understand it.
Unless you had 42 abdominal surgeries in your teens, we really don't want the entire unexpurgated life history of your alimentary canal since 3rd grade, but if you do have some serious issues, by all means fill us in. Start with why you're here right now.
Then, if applicable, recall your last menstrual period, particularly if it seems to have been 8 or 9 months ago.
And if you have an IM, gastro, gyno, renal, etc. specialist(s) you see or have seen, by all means, their name and phone number.
Minus points if you deny significant history, and then we find a scar around your middle big enough to swap body parts, or even find those cute little nicks on the sides that tell us someone's been worked on by laparoscopy.
And for f***'s sake, NO, YOU CAN'T HAVE ANYTHING TO EAT OR DRINK, UNLESS IT'S
1) A COUPLE OF CHIPS OF ICE TO WET YOUR MOUTH AFTER THE OPIATE PAIN RELIEVER MAKES YOU FEEL LIKE YOU'VE BEEN SUCKING ON COTTON SOCKS, OR,
2) IF YOU'RE REALLY LUCKY, YOU CAN GUZZLE SOME OF THAT NUMMY RANDOM FRUIT-FLAVORED CT CONTRAST.
Re-read that menu above, and note that it doesn't contain double cheeseburgers, anchovy pizza, or Flaming Hot Jalapeno Cheetos, or anything else, whatsoever. Try and remember that sneaking that stuff in past us anyways is all fun and games, until your surgery is delayed because the risks of anesthesia are too great with your recent meal, so now you have to sit around and feel your appendix bursting, because the anesthesiologist isn't going to risk getting sued when you vomit during surgery, aspirate, and become a bigger brain-dead vegetable head than you were when you snuck the Monster Whopper with Fries down your gaping maw while waiting for the CT scan.
But please, do understand that if you keep pushing the point, eventually we'll realize you don't just have an abdominal problem, you also have the brain of a stegosaurus pulsing, peanut-like, somewhere inside your great empty cranial vault.
Patient Safety tip: we also frown on people laughing at sit-coms while they wait yet subsequently reporting that their pain is a "10 out of 10"; ditto if we had to wake you up to ask you how much it's troubling you. Imagine Wile E. Coyote, the boxful of knives and sharp objects, and the rock ledge he fell off of landing on your tenderest spot - if you're feeling that, and we walk in to see you doubled over, sweating, moaning, and writhing, we'll buy it. Otherwise, we'll write down your "10", then record "patient was in no distress, smiling and laughing" which is medical chartese for "horrible actor, terrible liar, and no Oscar nomination". Doubly so if you're "in pain" when we ask, but look just fine when we sneak a peek over your shoulder a minute later from the hallway (trust me, we do this a lot - thank the local drug seeking junkies); if that happens, you're so busted. Please, I beg you, don't be that guy. It's cold in Siberia, and mentally, everyone will banish you there.
If you do all this, you'll save us a lot of wasted effort, and yourself several extra wasted hours on what's liable to be a 2-4 hour process. Which, despite everyone's best intentions, still may fail to find a diagnosable condition or cause for your pain. Which doesn't mean you don't have anything, just that we can't tell you what it is, how to fix it, or when it will go away.
And a lot like the atypical chest pain patient, if we send you home, it means whatever it is isn't going to kill you imminently, even if you still think you're going to die.
The same is true for your child, and for the same reasons. When you get bored, fed up, or exasperated with the process, remember you came to us for a good reason, and we aren't kidding when we make you sign the AMA form, and list possible outcomes starting with "DEATH". We yell because we care.
But you may still need to follow up with a specialist, rather than come back here serially after refusing to do the follow up, because "the mystery pain is back". Which quote is how we'll soon lovingly refer to your return visit if you keep pulling this schtick without doing what you were told.
Live and learn.
tummy ache.
Sometimes, you helpfully narrow it down to a flank or a quadrant, and other times, not so much.
Which is why it's called Mystery Abdominal Pain.
Which occasions the triage nurse getting out their deerstalker cap and meerschaum, and playing Sherlock Holmes with you, crossed with a really thorough police interrogation. (Tip to family members: shaddup, and let us get the answers the patient has. We'll be happy to let you fill things in afterwards, but first things first, 'kay?)
For the anatomically vague, a brief lesson.
Chest pain is rather straightforward, there being far less "stuff" to deal with: heart, two lungs, ribs and muscles. Yes, there are other things there for more detail-oriented folks, but that's the highlights. And even then, >5 out of 10 patients with chest pain go home with a diagnosis of "atypical chest pain", which means it's probably not a heart attack, pulmonary embolism, broken ribs, aortic aneurysm, tumor, or 27 other things, and we don't know what it is, but we're relatively certain it isn't going to kill you - tonight, anyway.
Abdomens are a bit more problematic. You have a diaphragm, esophagus, stomach, liver, gall bladder, two kidneys, pancreas, spleen, two different intestines, an appendix hanging out down in the corner, and for those with the internal plumbing option, a full set of female tackle for gestating and producing offspring.
Things that'll kill you relatively soon are things like appendicitis and an ectopic pregnancy. Everything else may only make you wish you were dead. We'll be focusing on the life-threatening options first, and trying to narrow things down as we move along.
Either way, to find out, we're going to need to do a few things. Things like blood tests for standard labs, a CT and/or ultrasound, and we need your pee to make sure you aren't pregnant. For the record, the more sure you are that you "couldn't possibly be" so, without a picture of your uterus in a jar, for any female between about 5 and 50, generally just convinces us you're lying at worst, and mistaken at best, so work with us, and just give up the pee, 'kay?
This is where you can shine, and help yourself: see that computer you're reading this on? When you finish, go to your word processor, and type in your allergies, medical history (that means the things someone with "M.D." after their name has actually clinically told you you have, not the things you Googled before you came in or think you have), along with any surgeries, and a pretty good breakdown on your problem as you understand it.
Unless you had 42 abdominal surgeries in your teens, we really don't want the entire unexpurgated life history of your alimentary canal since 3rd grade, but if you do have some serious issues, by all means fill us in. Start with why you're here right now.
Then, if applicable, recall your last menstrual period, particularly if it seems to have been 8 or 9 months ago.
And if you have an IM, gastro, gyno, renal, etc. specialist(s) you see or have seen, by all means, their name and phone number.
Minus points if you deny significant history, and then we find a scar around your middle big enough to swap body parts, or even find those cute little nicks on the sides that tell us someone's been worked on by laparoscopy.
And for f***'s sake, NO, YOU CAN'T HAVE ANYTHING TO EAT OR DRINK, UNLESS IT'S
1) A COUPLE OF CHIPS OF ICE TO WET YOUR MOUTH AFTER THE OPIATE PAIN RELIEVER MAKES YOU FEEL LIKE YOU'VE BEEN SUCKING ON COTTON SOCKS, OR,
2) IF YOU'RE REALLY LUCKY, YOU CAN GUZZLE SOME OF THAT NUMMY RANDOM FRUIT-FLAVORED CT CONTRAST.
Re-read that menu above, and note that it doesn't contain double cheeseburgers, anchovy pizza, or Flaming Hot Jalapeno Cheetos, or anything else, whatsoever. Try and remember that sneaking that stuff in past us anyways is all fun and games, until your surgery is delayed because the risks of anesthesia are too great with your recent meal, so now you have to sit around and feel your appendix bursting, because the anesthesiologist isn't going to risk getting sued when you vomit during surgery, aspirate, and become a bigger brain-dead vegetable head than you were when you snuck the Monster Whopper with Fries down your gaping maw while waiting for the CT scan.
But please, do understand that if you keep pushing the point, eventually we'll realize you don't just have an abdominal problem, you also have the brain of a stegosaurus pulsing, peanut-like, somewhere inside your great empty cranial vault.
Patient Safety tip: we also frown on people laughing at sit-coms while they wait yet subsequently reporting that their pain is a "10 out of 10"; ditto if we had to wake you up to ask you how much it's troubling you. Imagine Wile E. Coyote, the boxful of knives and sharp objects, and the rock ledge he fell off of landing on your tenderest spot - if you're feeling that, and we walk in to see you doubled over, sweating, moaning, and writhing, we'll buy it. Otherwise, we'll write down your "10", then record "patient was in no distress, smiling and laughing" which is medical chartese for "horrible actor, terrible liar, and no Oscar nomination". Doubly so if you're "in pain" when we ask, but look just fine when we sneak a peek over your shoulder a minute later from the hallway (trust me, we do this a lot - thank the local drug seeking junkies); if that happens, you're so busted. Please, I beg you, don't be that guy. It's cold in Siberia, and mentally, everyone will banish you there.
If you do all this, you'll save us a lot of wasted effort, and yourself several extra wasted hours on what's liable to be a 2-4 hour process. Which, despite everyone's best intentions, still may fail to find a diagnosable condition or cause for your pain. Which doesn't mean you don't have anything, just that we can't tell you what it is, how to fix it, or when it will go away.
And a lot like the atypical chest pain patient, if we send you home, it means whatever it is isn't going to kill you imminently, even if you still think you're going to die.
The same is true for your child, and for the same reasons. When you get bored, fed up, or exasperated with the process, remember you came to us for a good reason, and we aren't kidding when we make you sign the AMA form, and list possible outcomes starting with "DEATH". We yell because we care.
But you may still need to follow up with a specialist, rather than come back here serially after refusing to do the follow up, because "the mystery pain is back". Which quote is how we'll soon lovingly refer to your return visit if you keep pulling this schtick without doing what you were told.
Live and learn.
Friday, September 6, 2013
Watch This Space
There hasn't been anything bubbling to get out, and it's been a stunningly beautiful summer outside, so I've been recharging and just playing around, which doesn't contribute to blogging much.
The Stupidity Meter at work doesn't seem to have ratcheted down any though, so I'm sure to have a thing or twelve to put up presently.
Hope anyone who drops by has had some summer vacay time as well, because sunshine really is the best disinfectant.
More to come soon.
Cheers.
The Stupidity Meter at work doesn't seem to have ratcheted down any though, so I'm sure to have a thing or twelve to put up presently.
Hope anyone who drops by has had some summer vacay time as well, because sunshine really is the best disinfectant.
More to come soon.
Cheers.
Friday, July 19, 2013
There Are No Stupid Questions, Only Stupid People
From time to time, just to do an internet pulse check, I tab through my own stats to see what's bringing people here.
Sometimes it's surprising, or a I find a new blog, or I see someone has thoughtfully given me a shout out and there's a spike in page views.
And then there's today's little moment of mirth for moi.
Because one of the categories I find the most interesting is to see what keywords and searches dumped people on my little island in the Matrix.
One of this week's snort-worthy queries to the gods of Google and Bing was:
"how can you fight your ncclex score".
So if you end up here in general, or at this post because I put NCLEX in it, allow me to give you a leg up on this difficult and pressing question, especially for would-be nurses.
Here is the seldom-revealed-in-such-clarity, Top Secret:Codeword Access Sooper-Dooper Guaranteed Method to crack this deal wide open, and solve your NCLEX problem.
DON'T BE A DUMBASS. Study. Learn. Succeed.
I'm pretty sure I covered both study and test-taking strategies for your boards in the middle of 3 essays towards the new grads, a few weeks back.
So, sportsfans, in case you figure your state nursing board is going to jump back once you sic your lawyer, J. Noble Daggett on them, and cough up a passing board score because the sun was in your eyes that day, allow me to offer you a great deal on a barely used bridge right next to some beachfront property in New Mexico. Just send me your credit card number, bank account information, social security number and your ATM PIN, and I'll get right back to you.
(If that sarcasm went over your head, go back to beautician school, or perhaps consider a career in either food service or janitorial endeavors.)
You aren't going to "fight" your NCLEX score, as a rule. And in case no one ever let you in on this tip, let me let the cat out of the bag:
Your patients don't come with four handy multiple choice options tattooed on their chests.
That means you have to use Mr. Brain to come up with actual thoughts, and then behave appropriately and arrive at a rational course of action, based on what you see.
Y'know, pretty much how 99.9998% of the rest of life works.
So if you've somehow arrived at your nursing boards, and bungled them, either regroup and do better, or go home. But abandon any thought of arguing your way to a passing score if you didn't earn one. If you flunked your boards, let me be the first one to encourage you to try again. And if that amount of integrity and honesty with yourself eludes you, let me be the first one to say I'm really glad you're not a nurse, and I hope you never get to be one without undergoing a successful brain and character double transplant, if a donor match becomes available.
Because if test-taking kicks your ass, in a situation where you have oodles of time to successfully pick one of four letters on a keyboard, in an ideal test environment, the last place I want you to be placed is at a patient's bedside when some serious crap is going down. Try to remember that your kindergarten teacher lied to you, you aren't the most special snowflake, and if you can't hack the easy stuff to get this gig, you sure as shooting aren't going to be able to handle the life-and-death stuff day in and day out for twenty to forty years.
So please, either perform a Valsalva Maneuver (look it up!) until you hear a loud popping sound, and your head breaks suction from where you had it stuck, or pursue another career endeavor.
But thank you, whoever you are, for providing me the chance to mock your anonymous and unintended flash of honesty, once I found your jam-smeared fingerprints all over the NCLEX cookie jar. But please, pull your pants up from around your ankles, and decide if you're serious about this profession, or just comedy relief.
Sometimes it's surprising, or a I find a new blog, or I see someone has thoughtfully given me a shout out and there's a spike in page views.
And then there's today's little moment of mirth for moi.
Because one of the categories I find the most interesting is to see what keywords and searches dumped people on my little island in the Matrix.
One of this week's snort-worthy queries to the gods of Google and Bing was:
"how can you fight your ncclex score".
So if you end up here in general, or at this post because I put NCLEX in it, allow me to give you a leg up on this difficult and pressing question, especially for would-be nurses.
Here is the seldom-revealed-in-such-clarity, Top Secret:Codeword Access Sooper-Dooper Guaranteed Method to crack this deal wide open, and solve your NCLEX problem.
DON'T BE A DUMBASS. Study. Learn. Succeed.
I'm pretty sure I covered both study and test-taking strategies for your boards in the middle of 3 essays towards the new grads, a few weeks back.
So, sportsfans, in case you figure your state nursing board is going to jump back once you sic your lawyer, J. Noble Daggett on them, and cough up a passing board score because the sun was in your eyes that day, allow me to offer you a great deal on a barely used bridge right next to some beachfront property in New Mexico. Just send me your credit card number, bank account information, social security number and your ATM PIN, and I'll get right back to you.
(If that sarcasm went over your head, go back to beautician school, or perhaps consider a career in either food service or janitorial endeavors.)
You aren't going to "fight" your NCLEX score, as a rule. And in case no one ever let you in on this tip, let me let the cat out of the bag:
Your patients don't come with four handy multiple choice options tattooed on their chests.
That means you have to use Mr. Brain to come up with actual thoughts, and then behave appropriately and arrive at a rational course of action, based on what you see.
Y'know, pretty much how 99.9998% of the rest of life works.
So if you've somehow arrived at your nursing boards, and bungled them, either regroup and do better, or go home. But abandon any thought of arguing your way to a passing score if you didn't earn one. If you flunked your boards, let me be the first one to encourage you to try again. And if that amount of integrity and honesty with yourself eludes you, let me be the first one to say I'm really glad you're not a nurse, and I hope you never get to be one without undergoing a successful brain and character double transplant, if a donor match becomes available.
Because if test-taking kicks your ass, in a situation where you have oodles of time to successfully pick one of four letters on a keyboard, in an ideal test environment, the last place I want you to be placed is at a patient's bedside when some serious crap is going down. Try to remember that your kindergarten teacher lied to you, you aren't the most special snowflake, and if you can't hack the easy stuff to get this gig, you sure as shooting aren't going to be able to handle the life-and-death stuff day in and day out for twenty to forty years.
So please, either perform a Valsalva Maneuver (look it up!) until you hear a loud popping sound, and your head breaks suction from where you had it stuck, or pursue another career endeavor.
But thank you, whoever you are, for providing me the chance to mock your anonymous and unintended flash of honesty, once I found your jam-smeared fingerprints all over the NCLEX cookie jar. But please, pull your pants up from around your ankles, and decide if you're serious about this profession, or just comedy relief.
Tuesday, July 2, 2013
Take Pity On The Newbs
As Whitecoat's blog has reminded me, it's July.
Which, for those of you in teaching hospitals, means the new kids have been rolled out from med school and internships, and so Summertime Santa has delivered your shiny new batch of ER residents. The ones with about 5 minutes' experience, at this point.
Counting the time to get their name badges from security.
There will come a time to begin lovingly screwing with them a bit, but for now, handle them gently, like baby chicks and newborn bunnies. Everyone is new at some point. The Golden Rule applies.
I remember when I had a whole year of the ER under my belt at Seventh Circle Of Hell Hospital, when I had the unknown-to-me realization that "OMG, I know MORE than the DOCTOR!?!"
Because I experienced, on a lovely summer night one July, the dawning of comprehension of that fact courtesy of just such a larval example of the ER doc.
I'd been a nurse for most of a decade at that point, and done pre-hospital work for even longer, but my time in the big-time ER was just about at my first anniversary, so this was a new experience for me too. (Remember what I said about everyone being new at some point? There you go.)
So imagine my growing astonishment at finding a brand new ER resident, fresh out of his wrapping, as it became apparent he was staring at the patient chart in front of him, blank except for a Chief Complaint and curt but clear triage notes, evidently hoping for all the world that the very page would suddenly gain the power of speech, and exclaim to Dr. Freshmeat what in the wide world he should do.
As I ambled up to him, thinking perhaps there were some order I should note, I became aware that the entire chart was blank.
"Has the doctor seen the patient yet?" I asked.
"I'm the doctor." he said, and we introduced ourselves.
"So, first day?"
"First hour. I'm wondering what to do."
Honesty like that generally demands mercy, and he was a decent-seeming guy.
"Well Doc, usually with chest pain patients, besides the 12-lead EKG he already has, we do a stat chest x-ray, basic metabolic panel, CBC, and cardiac enzymes, repeated up to times 4, to rule out an MI." Because I'm not a genius, but after doing the same thing 500 times, I'd start to notice certain patterns...
"Great! Thanks!"
And he begins to scribble furiously in the orders block.
So figuring he's still got to actually see the guy, I move one bed down my area, just as the Head Attending, Dr. Doneitall, walks up to supervise Dr. Freshmeat, and ensure he hasn't killed anyone by 6:15PM.
"Dr. Freshmeat, tell me about your patient."
"He's got new onset chest pain, he has a negative initial 12-lead, so I'm ordering a stat chest X-ray, BMP, CBC, and serial EKGs and cardiac enzymes to rule out MI."
"Outstanding. Strong work. Carry on."
Which praise, at Seventh Circle Of Hell, from Dr. Doneitall, is the equivalent of Babe Ruth telling you you're a great baseball player. Especially to someone in his first hour in the ER.
Whereupon Dr. Freshmeat, behind Dr. Doneitall's turned back, whips around to me, throws me two thumbs up and a monstrous stage wink, and mouths "THANKS, DUDE!"
Because I just slowpitched him that hanging curve and he parked it in the bleachers. He just needed the initial nudge to help the textbook answers pop out of his forehead and flow onto the chart. Words cannot express how easy it was to work with Dr. Freshmeat the rest of his residency, and he did indeed grow into an excellent ER doc.
My other experience, growing after that night, was that I could generally run rings around the first-year residents, the second-years could keep up with me, and the third-year residents could bury me in orders in about 20 minutes that would kick my @$$ all night, and would, until they started to hone in on horses instead of zebras, and abandoned the shotgun approach to diagnostic work. It helped when they had the mentoring attendings, instead of the anal-retentive ones.
So unless they're total dicks from the get-go, cut the new kids some slack.
Keep an eye on them, shove them in the right direction from time to time, and help them to succeed, and it'll generally pay off. If not for you, for their patients for the next 30 years.
You can always screw around with them after a few months go by, just about the time they start to get a little cocky.
Which, for those of you in teaching hospitals, means the new kids have been rolled out from med school and internships, and so Summertime Santa has delivered your shiny new batch of ER residents. The ones with about 5 minutes' experience, at this point.
Counting the time to get their name badges from security.
There will come a time to begin lovingly screwing with them a bit, but for now, handle them gently, like baby chicks and newborn bunnies. Everyone is new at some point. The Golden Rule applies.
I remember when I had a whole year of the ER under my belt at Seventh Circle Of Hell Hospital, when I had the unknown-to-me realization that "OMG, I know MORE than the DOCTOR!?!"
Because I experienced, on a lovely summer night one July, the dawning of comprehension of that fact courtesy of just such a larval example of the ER doc.
I'd been a nurse for most of a decade at that point, and done pre-hospital work for even longer, but my time in the big-time ER was just about at my first anniversary, so this was a new experience for me too. (Remember what I said about everyone being new at some point? There you go.)
So imagine my growing astonishment at finding a brand new ER resident, fresh out of his wrapping, as it became apparent he was staring at the patient chart in front of him, blank except for a Chief Complaint and curt but clear triage notes, evidently hoping for all the world that the very page would suddenly gain the power of speech, and exclaim to Dr. Freshmeat what in the wide world he should do.
As I ambled up to him, thinking perhaps there were some order I should note, I became aware that the entire chart was blank.
"Has the doctor seen the patient yet?" I asked.
"I'm the doctor." he said, and we introduced ourselves.
"So, first day?"
"First hour. I'm wondering what to do."
Honesty like that generally demands mercy, and he was a decent-seeming guy.
"Well Doc, usually with chest pain patients, besides the 12-lead EKG he already has, we do a stat chest x-ray, basic metabolic panel, CBC, and cardiac enzymes, repeated up to times 4, to rule out an MI." Because I'm not a genius, but after doing the same thing 500 times, I'd start to notice certain patterns...
"Great! Thanks!"
And he begins to scribble furiously in the orders block.
So figuring he's still got to actually see the guy, I move one bed down my area, just as the Head Attending, Dr. Doneitall, walks up to supervise Dr. Freshmeat, and ensure he hasn't killed anyone by 6:15PM.
"Dr. Freshmeat, tell me about your patient."
"He's got new onset chest pain, he has a negative initial 12-lead, so I'm ordering a stat chest X-ray, BMP, CBC, and serial EKGs and cardiac enzymes to rule out MI."
"Outstanding. Strong work. Carry on."
Which praise, at Seventh Circle Of Hell, from Dr. Doneitall, is the equivalent of Babe Ruth telling you you're a great baseball player. Especially to someone in his first hour in the ER.
Whereupon Dr. Freshmeat, behind Dr. Doneitall's turned back, whips around to me, throws me two thumbs up and a monstrous stage wink, and mouths "THANKS, DUDE!"
Because I just slowpitched him that hanging curve and he parked it in the bleachers. He just needed the initial nudge to help the textbook answers pop out of his forehead and flow onto the chart. Words cannot express how easy it was to work with Dr. Freshmeat the rest of his residency, and he did indeed grow into an excellent ER doc.
My other experience, growing after that night, was that I could generally run rings around the first-year residents, the second-years could keep up with me, and the third-year residents could bury me in orders in about 20 minutes that would kick my @$$ all night, and would, until they started to hone in on horses instead of zebras, and abandoned the shotgun approach to diagnostic work. It helped when they had the mentoring attendings, instead of the anal-retentive ones.
So unless they're total dicks from the get-go, cut the new kids some slack.
Keep an eye on them, shove them in the right direction from time to time, and help them to succeed, and it'll generally pay off. If not for you, for their patients for the next 30 years.
You can always screw around with them after a few months go by, just about the time they start to get a little cocky.
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