As an intern, you have accomplished what many others dream about, but few attain. You have your M.D., and you have a job to boot! While you deserve to be proud of your position, you should also begin to appreciate how much you have to prove. To prove yourself you must work hard and smart. You need to be flexible and hungry for knowledge. Your team depends on you to gather data and contribute to the plan for your patients. You are wading through the frequently rough waters of the clinical environment. Most of the time this means working with other staff beyond your seniors and residency staff. Learning how to communicate and work effectively with nurses is a top priority during this time. Many interns treat nurses professionally but still end up stepping on their toes without knowing why. Sometimes there may be confusion about orders that were handed down from the attending. Sometimes difficulties arise when the intern is unfamiliar with how things work on the floor. Let's explore six ways to get off to a good start with nurses and other staff during your rotations.
1. Go over your attending's orders with your nurse.
Most nurses appreciate an intern going over orders from the attending with them, as opposed to chasing the intern down the hallway to try to make out their handwriting. If the nurse is available, make an effort to review the orders. This practice is not always feasible but advisable especially when there is a high level of complexity in the care plan.
2. Communicate with your nurses.
As with any critical undertaking, communication is vital to the care of patients. Having a good sense of humor helps. Speaking to the nurse as if she is a professional goes a long way. He or she may look at patient care in a much different way than that of an intern. That's a good thing.
Try using "I" messages instead of "you" messages.
Measure your tone to avoid the appearance of yelling at the nurse. Instead of saying "You never got those test results!" try saying, "I really need those test results if you could please check on it, Jennifer."
3. Bring food as an ice-breaker.
Now, this is tried and true for many professionals, not just nurses. One way to break the ice is to bring food and introduce yourself before just helping yourself to charts behind the desk or taking them off where the nurses don’t know you have gone with them. Chocolate and sweets always work, but any food will do. It shows the medical intern appreciates the nurses. They are hungry and stressed up there on the seventh floor. OK, so it's a bribe. Still, it works.
4. Introductions matter.
When you introduce yourself to a nurse on the floor and say "Hello, I'm Dr. Kelly." , that tells your nursing colleagues next to nothing. With a revolving elevator door of specialists coming on and off the floor, nurses need to know what service you're representing. The intern might say instead, "Hello, I'm Dr. Kelly, a Family Medicine intern." Respect matters – your nurses are your eyes and ears. Nursing colleagues are glad to help an intern in any way they can, so ask politely and respect the nursing staff’s opinions. After all, they are spending more time with the patient than the intern is. The nurses are your eyes and ears. They have the intern’s back. A good nurse can save a medical intern from error more times than not.
That brings us back to the mention of food. Chocolates are great for an introduction. That's the number one thing nurses mention when asked how a medical intern can break the ice. They remember the interns that bring the food. If the intern wants to be memorable, bring the chocolate. Just making sure you’re paying attention.
5. Do you have a stethoscope? Bring it.
That brings the discussion to carrying your stethoscope. Yes, you can usually borrow one from the nursing staff, but please return it before leaving the floor. The same goes for pens, charts, and important documents. Medical schools and nursing schools should be on board with teaching nurses and medical interns to get along by sharing resources and information from the start. Sadly, this is not always the case. Try to avoid stoking adversarial tendencies by putting supplies and documents back where you found them. I have certainly been guilty of this infraction.
6. Lean on your senior residents and attendings for guidance.
Your senior residents and attendings know the ropes much more than you do. Inquire about the culture and priorities of the floors you will be rounding on. Find out what is essential to the staff around you so that you can establish common ground. Doing this can help you become more efficient when the pressure is on and time is scarce. Nurses and medical interns can learn to get along through some simple courtesy and communication techniques.
The themes to remember here are collaboration and respect. It takes excellent collaboration between nurses, interns, and attendings to provide excellent patient care. More and more, physicians should see their nurses as a critical resource who should be listened to carefully and with concern. Conversely, nurses should also understand the stress and constraints that interns endure. Working as a team toward excellent patient care is a worthy goal needed in all areas of medicine.
Earning mutual respect in the field of medicine is worth pondering when beginning a relationship with nurses as a medical intern. If it were easy, it wouldn't be so exciting. Remember, you can do this!