Unsolicited Advice to Interns From a Former RN Who has Gone to the Dark Side: Part 1

If you’re a new intern you are advisedly a little afraid of the new found responsibility in your life. I say ‘advisedly’ because there is nothing more frightening in healthcare than someone who is  ‘unconsciously incompetent’, i.e someone who doesn’t even realize he has no idea what he is doing.

In an effort to be helpful I thought I’d write a series of little posts from my former vantage point as an emergency nurse. (I say series because I am in the throes of USMLE cramming but as July marks the infusion of new interns in hospitals, this is the best time to write these. It'll be my 'study break' activity.)

When I was nursing I had the opportunity to see many medical students, interns, and residents flit in and out of the department, noting the differences between the ones who sail and the ones who sink. Here are some tips for those that want to sail. 

You Are Book Rich, Experience Poor. You may know all the cytokines involved in septic shock, but the RN knows what it looks like from 30 ft. Guess which of the two abilities is going to save your patient’s life? You'll get there, but in the mean time, pay attention to the patients about whom the RN’s are concerned. Which brings me to my next point.

Spidey Sense is not learned it is developed. Many nurses have been in health care since you were wearing short pants and they have pattern recognition down to a science (or some might say, a freakishly intuitive level). Good nurses know the ‘sick look’ so when they feel something ain’t right with a patient…it’s probably true. Do yourself a favor and check the patient out. Also, this is a good way to show your nurse colleagues that you respect their opinions.  You hate them because they paged you at 3 a.m when Ms Smith wasn’t looking right, but now they’ll love you because you took their concern seriously. And let me tell you newbies: Nurse love is the BEST love when you're the new kid on the team. Now you won’t get another phone call at 0345h to find out if you wanted that ‘diet as tolerated’ order ‘by mouth’. Not that that has ever happened…

Nurse speak. Nurses learn very quickly how to speak in code to 

a) forestall disaster, 

b) make you think something was your idea, 

c) point out a mistake without being unprofessional, 

d) make a suggestion without appearing to offer advice.   

Here are some translations for Nurse Speak. 

“Are you sure you want to [fill in procedure, medication, etc.] Mrs. Jones?” 

means “If you do that you’ll probably kill the patient”.

“Did you say you wanted a CXR on Mrs. Jones?” 

means “Yo! You forgot to order a chest x-ray, I am going to go ahead and order one now to save you time and not make you look like an idiot when you page medicine and then have to tell them you haven’t done a chest x-ray yet”.

“Oh, I haven’t seen it done that way before, I always thought you had to…” 

means “Dude, you are seriously doing that wrong, please let me show you a better/safer/faster way of doing that”. 

And finally, 

“Did you want me to go ahead and dip that urine for pregnancy?” 

means, “It appears you’ve left out a major differential, I’m going to make sure it has crossed your mind”. 

And that concludes today's installment of Unsolicited Advice. Hope some of that is helpful!